肺肉瘤样癌脑转移的高危因素及预后分析

为探索肺肉瘤样癌临床特征与脑转移之间的关系，建立预测肺肉瘤样癌脑转移发生风险的预测模型，并分析肺肉瘤样癌脑转移的预后。研究纳入监测、流行病学和最终结果(SEER)数据库中816例肺肉瘤样癌患者，收集其临床特征与预后数据。根据是否出现脑转移将患者分为两组，组间比较采用卡方检验或Fisher精确检验。采用单因素和多因素Logistic回归分析脑转移发生的高危因素，并构建预测列线图，使用C指数、校正曲线和决策曲线分析(decision curve analysis, DCA)来衡量列线图的检验效能。采用单因素和多因素COX回归进行肺肉瘤样癌脑转移患者的预后分析。结果表明：年龄、是否接受根治性手术为肺肉瘤样癌患者发生脑转移的独立预测因素。基于此构建了肺肉瘤样癌脑转移的概率预测列线图，C指数为0.768,DCA显示净收益率高，模型临床效能较好。脑转移患者的预后影响因素方面，研究发现，在脑转移基础上合并肺内转移的患者相较于合并其他部位转移的患者OS和CSS明显更差。

Risk Factors and Prognostic Analysis of Brain Metastasis in Pulmonary Sarcomatoid Carcinoma

This study was aimed to investigate the relationship between clinical characteristics and brain metastasis, establish a predictive model for the risk of brain metastasis, and analyze the prognosis of brain metastasis in pulmonary sarcomatoid carcinoma. 816 patients with pulmonary sarcomatoid carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database were included in the study whose clinical characteristics and prognosis data were collected. Patients were divided into two groups based on whether they were accompanied with brain metastasis. Inter-group comparisons were performed using the chi-square test or Fisher''s exact test. Univariate and multivariate logistic regression analyses were used to identify high-risk factors for the occurrence of brain metastasis and a predictive nomogram was constructed based on the results. The performance of the nomogram was assessed using the C-index, calibration curve, and decision curve analysis (DCA). Univariate and multivariate Cox regression analyses were conducted to analyze the prognosis of patients with pulmonary sarcomatoid carcinoma accompanied by brain metastasis. The results show that age (OR 2.815, 95% CI: 1.776-4.462, P<0.001)) and radical surgery (OR 0.085, 95% CI: 0.040-0.180, P<0.001)) were independent predictors for the occurrence of brain metastasis in patients with pulmonary sarcomatoid carcinoma. Based on these findings, a predictive nomogram for the risk of brain metastasis in pulmonary sarcomatoid carcinoma was developed, with a C-index of 0.768 (95% CI: 0.682-0.854). DCA demonstrated a high net benefit rate, indicating good clinical utility of the model. In terms of prognostic factors for brain metastasis, patients with combined pulmonary and intracranial metastasis had significantly worse overall survival (HR 1.757, 95% CI: 1.049-2.944, P=0.032) and cancer-specific survival (HR 1.849, 95% CI: 1.100-3.108, P=0.020) than patients with metastasis in other sites. It is concluded that age and radical surgery were independent predictive factors for brain metastasis in pulmonary sarcomatoid carcinoma. A predictive model for the risk of brain metastasis in pulmonary sarcomatoid carcinoma was developed based on these factors. For patients with pulmonary sarcomatoid carcinoma accompanied by brain metastasis, pulmonary metastasis revealed worse prognosis compared to metastasis in other sites.