Medical Student Jordan University of Science and Technology
Introduction: The prognosis of patients with non-small cell lung cancer (NSCLC) is poor, with most patients presenting in late stages and are prone to brain metastasis (BM). In this study, we aim to establish a nomogram to predict the likelihood of BM in NSCLC.
Methods: Data of patients diagnosed with NSCLC with or without brain metastasis between 1975 and 2019 was extracted from SEER database. We identified and randomized 16837 patients into a training (n=11786) and validation group (n=5051) using a 7:3 ratio. Univariate and multivariate logistic regression analysis was used to select significant predictive risk factors associated with BM in the training cohort. The established nomogram was validated by the area under curve (AUC) value, and calibration curves.
Results: We identified 1743 patients with confirmed brain metastasis and 15094 patients with no BM. Median overall survival (mOS) in patients with BM was 8.0 months (95% CI: 6.9-9.1), while mOS in patients without BM was not reached (p < 0.0001). Multivariate logistic regression analysis identified age, race, marital status, histology, T stage, N stage, metastasis to bone, metastasis to liver, metastasis to lymph nodes, local metastasis to lungs, and not receiving primary tumor resection (OR: 11.03; 95% CI: 8.33-14.62; p< 0.0001) to be associated with brain metastasis. The nomogram had excellent discriminatory performance demonstrated by AUC values of 0.85 and 0.83 in the training group and validation group, respectively. The calibration curves demonstrated agreement between the observed and predicted values for brain metastasis.
Conclusion : This nomogram can be used to identify NSCLC patients with a high risk for developing BM based on several demographic and clinicopathological factors. This will guide preventive and individualized treatment for NSCLC patients to improve their prognosis. Established preventive and therapeutic measures including prophylactic cranial irradiation, and primary surgical resection can be used for patients with high-risk for BM.
