Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Clin Neurol Neurosurg. 2024 Nov;246:108549. doi: 10.1016/j.clineuro.2024.108549. Epub 2024 Sep 11.
Brain metastases (BM) constitute the most common intracranial tumor in adults. Prior literature indicates the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score is associated with increased risk of cancer, potentially attributable to shared risk factors. Understanding the role of ASCVD risk scores in BM may help optimize their care and inform clinical decision-making. Our aim was to explore associations between ASCVD risk score in BM patients and their overall survival, hospital charges, and non-routine discharge disposition.
Electronic medical records were reviewed to collect clinical data for BM patients undergoing surgery at a single institution (2017-2021). Regression analyses were performed accordingly and maximally selected rank statistics were employed to identify an optimal cutoff for ASCVD risk scores. The random survival forest (RSF) machine learning technique identified the most important variable associated with survival outcomes in BM patients.
A total of 139 patients were included with average age 62.93±9.29 years, 48.2 % male, 25.2 % with high hospital charges, and 23.7 % experiencing non-routine discharge. Among these patients, 32.3 % had prior history of an ASCVD event, while 67.7 % did not. Overall, this cohort had an average 10-year ASCVD risk score of 12.51±12.98, indicating intermediate risk of ASCVD among all BM patients. On multivariate logistic regression, prior history of ASCVD was associated with higher odds of high hospital charges (OR=3.670, p=0.018), and higher ASCVD risk scores were associated with greater odds of non-routine discharge (OR=1.059, p=0.012). On the multivariate Cox regression model, higher ASCVD risk scores correlated with worse overall survival (HR=1.031, p=0.014). A threshold of 25.1 was identified for high-risk ASCVD scores. Patients with ASCVD scores >25.1 exhibited reduced overall survival in Kaplan-Meier analysis (p=0.015) and multivariate Cox regression (HR: 2.811, p=0.016). Notably, ASCVD risk scores were found to be the most important variable in predicting worse survival outcomes in BM patients compared to other established frailty indices.
This study indicates higher ASCVD risk scores in BM patients are associated with worse overall survival. Integrating ASCVD assessment into clinical workflow may facilitate more informed risk-based decision-making.
脑转移瘤（BM）是成人中最常见的颅内肿瘤。先前的文献表明，10 年动脉粥样硬化性心血管疾病（ASCVD）风险评分与癌症风险增加相关，这可能归因于共同的风险因素。了解 ASCVD 风险评分在 BM 中的作用可能有助于优化其治疗，并为临床决策提供信息。我们的目的是探讨 BM 患者的 ASCVD 风险评分与总生存期、住院费用和非常规出院处置之间的关系。
对一家医疗机构（2017-2021 年）接受手术治疗的 BM 患者的电子病历进行了回顾性分析，以收集临床数据。相应地进行了回归分析，并采用最大选择秩统计方法确定了 ASCVD 风险评分的最佳截断值。随机生存森林（RSF）机器学习技术确定了与 BM 患者生存结果最相关的最重要变量。
共纳入 139 例患者，平均年龄 62.93±9.29 岁，48.2%为男性，25.2%的患者住院费用较高，23.7%的患者非常规出院。在这些患者中，32.3%有 ASCVD 病史，67.7%没有。总体而言，该队列的平均 10 年 ASCVD 风险评分为 12.51±12.98，表明所有 BM 患者的 ASCVD 风险处于中等水平。多变量逻辑回归分析显示，ASCVD 病史与较高的住院费用发生率相关（OR=3.670，p=0.018），而较高的 ASCVD 风险评分与非常规出院的发生率较高相关（OR=1.059，p=0.012）。多变量 Cox 回归模型显示，较高的 ASCVD 风险评分与较差的总生存期相关（HR=1.031，p=0.014）。确定了 ASCVD 高风险评分的阈值为 25.1。在 Kaplan-Meier 分析（p=0.015）和多变量 Cox 回归分析（HR：2.811，p=0.016）中，ASCVD 评分>25.1 的患者总生存期明显缩短。值得注意的是，与其他已建立的脆弱性指数相比，ASCVD 风险评分是预测 BM 患者生存结果较差的最重要变量。
本研究表明，BM 患者的 ASCVD 风险评分较高与总生存期较差相关。将 ASCVD 评估纳入临床工作流程可能有助于做出更明智的基于风险的决策。
