The incidence, risk factors and predictive nomograms for early death of lung cancer with synchronous brain metastasis: A retrospective study in the SEER database

Abstract

\n Background\n\nPatients of lung cancer with synchronous brain metastases (LCBM) have a poor prognosis and die within a short period of time. However, little is known about the early mortality and related factors of LCBM patients.\nMethods\n\nPatients with LCBM diagnosed between 2010 and 2016 were enrolled from the surveillance, epidemiology, and end result (SEER). Significant independent prognostic factors were identified by univariate and multivariate logistic regression analyses. Nomograms of overall and cancer-specific early death were constructed using independent risk factors. The prediction ability and clinical application value of the model was verified by receiver operating characteristic (ROC) and decision curve analyses (DCAs).\nResults\n\nA total of 29902 cases of LCBM patients were enrolled in this study. 44.4% had early deaths, of which 38.2% died of lung cancer. Age, race, gender, Gleason grade, histological type, T stage, N stage, bone metastasis, liver metastasis, surgery, radiotherapy, chemotherapy and marital status were significant independent risk factors of overall and cancer-specific early death and was used to construct the nomogram. The areas under the curve (AUC) of the training group were 0.828 (95%CI: 0.822–0.833) and 0.800 (95%CI: 0.794–0.806) in the model of overall and cancer-specific early death, respectively. The DCA analysis showed that the model had good clinical benefits and utility\nConclusions\n\nWe established a comprehensive nomogram to distinguish early death in lung cancer patients with synchronous brain metastases which may help oncologists develop better treatment strategies, such as clinical trials and hospice care.