美国中年脑转移瘤：男性有风险吗？
Midlife brain metastases in the United States: Is male at risk?
机构信息
Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
出版信息
Cancer Med. 2022 Feb;11(4):1202-1216. doi: 10.1002/cam4.4499. Epub 2022 Jan 12.
BACKGROUND
Population-based estimates of the impact of gender throughout the whole course of brain metastases (BMs) at the time of diagnosis of systemic malignancies are insufficient. We aimed to discover the influence of gender on the presence of BMs in newly diagnosed malignancies and the survival of those patients on a population-based level.
METHODS
Midlife patients (40 years ≤ age ≤60 years) with newly diagnosed malignancies and BMs at the time of diagnosis were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. Clinical variables adjusted patient data. The LASSO regression was performed to exclude the possibility of collinearity. Univariable and multivariable logistic regression analyses were applied to find independent predictors for the presence of BMs, while univariable and multivariable Cox proportional hazard regression analyses were used to determine prognosticators of survival. K-M curves were used to perform the survival analysis.
RESULT
276,327 population-based samples met inclusion criteria between 2014 and 2016, and 5747 (2.08%) patients were diagnosed with BMs at the time of diagnosis of systematic malignancies. Among all midlife patients with cancer, 44.02% (121,634) were male, while 51.68% (2970) were male among patients with BMs at the time of diagnosis. The most frequent tumor type was breast cancer (23.11%), and lung cancer had the highest incidence proportion of BMs among the entire cohort (19.34%). The multivariable logistic regression model suggested that female (vs. male, odds ratio [OR] 1.07, 95% CI: 1.01-1.14, p < 0.001) was associated with a higher risk of the presence of BMs at the time of diagnosis. Moreover, in the multivariable Cox model for all-cause mortality in individuals with BMs at diagnosis, female (vs. male, hazard ratio [HR], 0.86, 95% CI, 0.80-0.92, p < 0.001) was shown to have a lower risk of decreased all-cause mortality.
CONCLUSION
The middle-aged females were at increased risk of developing BMs, while the middle-aged males with BMs were at higher risk of having poorer survival.
背景
人口统计学研究表明，在诊断全身恶性肿瘤时，整个脑转移（BM）病程中性别对其的影响尚不清楚。本研究旨在从人群层面上发现性别对新发恶性肿瘤患者 BM 发生率及该人群 BM 患者生存的影响。
方法
从国家癌症研究所的监测、流行病学和最终结果（SEER）数据库中提取 40 岁至 60 岁之间的中年新发恶性肿瘤患者和诊断时患有 BM 的患者。对临床变量进行调整以校正混杂因素。采用 LASSO 回归排除共线性的可能性。单变量和多变量逻辑回归分析用于寻找 BM 存在的独立预测因素，单变量和多变量 Cox 比例风险回归分析用于确定生存的预后因素。使用 K-M 曲线进行生存分析。
结果
2014 年至 2016 年间，共有 276327 个基于人群的样本符合纳入标准，其中 5747（2.08%）名患者在诊断全身恶性肿瘤时被诊断为 BM。在所有患有癌症的中年患者中，44.02%（121634 名）为男性，而在诊断时患有 BM 的患者中，男性占 51.68%（2970 名）。最常见的肿瘤类型是乳腺癌（23.11%），而在整个队列中，肺癌的 BM 发病率最高（19.34%）。多变量逻辑回归模型表明，女性（与男性相比，比值比 [OR] 1.07，95%置信区间：1.01-1.14，p<0.001）与诊断时 BM 存在的风险较高相关。此外，在诊断为 BM 的个体的全因死亡率的多变量 Cox 模型中，女性（与男性相比，风险比 [HR] 0.86，95%置信区间，0.80-0.92，p<0.001）的全因死亡率降低风险较低。
结论
中年女性发生 BM 的风险增加，而患有 BM 的中年男性的总体生存风险更高。
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