Wang Fei, Wang Xihao, Feng Zhigang, Li Jun, Xu Hailiang, Lu Hengming, Wang Lianqu, Li Zhihui
Department of Reproductive Medicine, Central Hospital of Zhumadian, Henan, China.
Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China.
Front Immunol. 2025 Jun 30;16:1572580. doi: 10.3389/fimmu.2025.1572580. eCollection 2025.
BACKGROUND: Existing research on the development of prognostic models for renal cell carcinoma (RCC) patients with brain metastases (BM) remains limited. This study aimed to develop a prognostic prediction model for RCC patients with BM and to identify critical factors influencing clinical outcomes. METHODS: Patients diagnosed with BM between 2010 and 2019 were identified and extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Potential risk factors were initially screened applying the eXtreme Gradient Boosting (XGBoost) and Random Forest (RF) machine learning algorithms. Subsequently, multivariate COX regression analysis was performed to identify independent risk factors for constructing the predictive nomogram. Nomogram performance was comprehensively evaluated based on Harrell's concordance index (C-index), receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA). The SHapley Additive exPlanations (SHAP) method was employed to demonstrate the ranking of feature importance affecting patient prognosis at different time points. Moreover, we conducted propensity score matching (PSM) and Kaplan-Meier (K-M) survival analysis to compare clinical outcomes between surgical and non-surgical treatment subgroups. RESULTS: In total, 982 patients were assigned to the training cohort and 420 to the validation cohort. The constructed nomogram included four clinical variables: histologic type, T stage, N stage, surgery and chemotherapy. The AUC, C-index, calibration curves, and DCA curves showed excellent performance of the nomogram. In addition, the SHAP values indicated that surgical treatment was the most important prognostic risk factor for OS at 6-months, 1-year, 2-years, and 3-years. After further balancing the baseline characteristics between the surgical and non-surgical groups using PSM, we observed that patients with BM who underwent surgical intervention showed significantly better survival outcomes across all subgroups compared to non-surgical patients, though unmeasured confounders may contribute to this association. CONCLUSION: We developed a novel nomogram for predicting prognostic factors in RCC patients with BM, offering a valuable tool to support accurate clinical decision-making. Our research also confirmed that surgical intervention was significantly associated with improved survival outcomes for patients with BM.
背景:关于肾细胞癌(RCC)脑转移(BM)患者预后模型开发的现有研究仍然有限。本研究旨在开发一种针对RCC合并BM患者的预后预测模型,并确定影响临床结局的关键因素。 方法:从监测、流行病学和最终结果(SEER)数据库中识别并提取2010年至2019年间诊断为BM的患者。最初应用极端梯度提升(XGBoost)和随机森林(RF)机器学习算法筛选潜在风险因素。随后,进行多变量COX回归分析以确定构建预测列线图的独立风险因素。基于Harrell一致性指数(C指数)、受试者工作特征(ROC)曲线分析、校准图和决策曲线分析(DCA)对列线图性能进行全面评估。采用SHapley加性解释(SHAP)方法展示不同时间点影响患者预后的特征重要性排名。此外,我们进行了倾向评分匹配(PSM)和Kaplan-Meier(K-M)生存分析,以比较手术和非手术治疗亚组之间的临床结局。 结果:总共982例患者被分配到训练队列,420例被分配到验证队列。构建的列线图包括四个临床变量:组织学类型、T分期、N分期、手术和化疗。AUC、C指数、校准曲线和DCA曲线显示列线图具有优异的性能。此外,SHAP值表明手术治疗是6个月、1年、2年和3年总生存期最重要的预后风险因素。在使用PSM进一步平衡手术组和非手术组之间的基线特征后,我们观察到与非手术患者相比,接受手术干预的BM患者在所有亚组中的生存结局均显著更好,尽管未测量的混杂因素可能导致这种关联。 结论:我们开发了一种用于预测RCC合并BM患者预后因素的新型列线图,为支持准确的临床决策提供了有价值的工具。我们的研究还证实,手术干预与BM患者生存结局的改善显著相关。
Clin Orthop Relat Res. 2024-9-1
Eur J Cancer. 2024-12
Cochrane Database Syst Rev. 2024-6-7