基于竞争风险模型的肺腺癌继发脑转移危险因素分析

Risk Factors for Secondary Brain Metastasis in Lung Adenocarcinoma Based on Competitive Risk Model

摘要: 目的：应用竞争风险模型探讨肺腺癌发生脑转移的影响因素并进行预测分析。材料和方法：收集2010年8月至2018年5月山西省肿瘤医院收治的938例经病理确诊的肺腺癌的患者，其中发生脑转移者222例，未发生脑转移者716例。以肺腺癌作为暂态，脑转移与发生脑转移前死亡分别作为两个吸收态，发生脑转移前死亡为脑转移的竞争风险事件，构建竞争风险模型，获得模型参数，分析肺腺癌发生脑转移的影响因素，从而对肺腺癌发生脑转移进行风险评估。结果：单因素分析结果显示，性别、吸烟状态、EGFR突变状态、T分期、N分期、有无颅外转移以及不同的治疗方法是促进肺腺癌发生脑转移的可能危险因素。多因素竞争风险模型筛选，N3分期且有颅外转移与肺腺癌发生脑转移风险升高显著相关，N3分期且有颅外转移的患者(194人) 2年发生脑转移率为80.932% (95%CI = 77.325%~84.539%)。结论：根据竞争风险模型，肺腺癌患者中，N3期和颅外转移是脑转移的高危亚组。最可能获益于预防性脑照射。将来预防性脑照射的临床研究应该聚焦于该高危亚组。

Abstract: Objective: To explore the influencing factors of brain metastasis in lung adenocarcinoma using competitive risk model and make predictive analysis. Materials and methods: A total of 938 patients with pathologically confirmed lung adenocarcinoma admitted to Shanxi Cancer Hospital from August 2010 to May 2018 were collected, including 222 patients with brain metastasis and 718 patients without brain metastasis. Brain metastases from lung adenocarcinoma as transient, and brain metastases before death as two absorbing states respectively, brain metastases die before competition risk events for brain metastases, build competitive risk model, get the model parameters, analyze the influence factors of brain metastases from lung adenocarcinoma, and conduct the risk assessment of brain metastasis in lung adenocarcinoma. Results: Univariate analysis showed that gender, smoking status, EGFR mutation status, T stage, N stage, presence or absence of extracranial metastasis and different treatment methods were possible risk factors for brain metastasis in lung adenocarcinoma. Multivariate competitive risk model screening showed that N3 stage patients with extracranial metastasis were significantly correlated with increased risk of brain metastasis in lung adenocarcinoma, and the 2-year brain metastasis rate in 194 patients with N3 stage patients with extracranial metastasis was 80.932% (95%ci = 77.325% - 84.539%). Conclusion: According to the competitive risk model, stage N3 and extracranial metastasis are the high-risk subgroups of brain metastasis in patients with lung adenocarcinoma. Prophylactic brain irradiation is the most likely benefit. Future clinical studies on prophylactic brain irradiation should focus on this high-risk subgroup.