Risk Factors For Advanced NSCLC Patients With Brain Metastasis And Its Correlation Between Imaging Features And Molecular Classification

Objective:(1)To investigate the risk factors for brain metastasis in patients with advanced non-small cell lung cancer(NSCLC),and to calculate the incidence of brain metastasis by the number of risk factors,so as to provide a screening basis for early clinical identification and prevention of brain metastasis;(2)To explore the relationship between the clinical and imaging features of patients with advanced NSCLC brain metastases and the molecular classification of Epidermal Growth Factor Receptor(EGFR),to provide a basis for the identification of NSCLC brain metastases of different molecular classifications,and to use EGFR tyrosine kinase inhibitor(TKI)for patients who cannot be detected by EGFR.Methods: This study retrospectively collected the complete clinical data of 197 patients with NSCLC who were pathologically diagnosed as stage IIIB-IV in the Affiliated Hospital of Yan’an University from August 2020 to February 2023,and determined the independent risk factors for brain metastasis through univariate analysis and logistic multivariate regression analysis.Among them,the clinical and imaging data of 56 patients with brain metastasis and clear EGFR molecular classification were collected,and they were divided into EGFR mutation group and EGFR wild group,and the correlation between the imaging characteristics of brain metastases and EGFR molecular classification was analyzed.Results:(1)Among the 197 patients who met the study conditions,a total of 73 patients developed brain metastases,and the brain metastasis rate was 37.1%.(2)Univariate analysis showed that age,pathological type,smoking history,and sex may be risk factors for brain metastasis in patients with stage IIIB-IV NSCLC.(3)The results of logistic multivariate regression analysis showed that young patients(<64 years old)with non-squamous cell carcinoma were independent risk factors for brain metastasis in patients with stage IIIB-IV NSCLC.(4)From no risk factors to two risk factors,the incidence of brain metastases increased from 11.43% to 53.62%.(5)In patients with brain metastasis in this study,the proportion of adenocarcinoma and non-smoking patients in the EGFR mutant group was significantly higher than that in the EGFR wild group(P<0.05).The proportion of meningeal metastasis in the EGFR mutant group was higher than that in the EGFR wild group,but the difference was not statistically significant(P>0.05).(6)The difference in the enhancement mode of brain metastases between the two groups was statistically significant(P=0.021),and further pairwise comparison showed that nodular enhancement was more likely in the EGFR mutant group than in the EGFR wild group(P=0.019).(7)There were no significant differences in gender,age,primary lesion location,metastasis mode,number of metastases,size,degree of edema,and whether there was bleeding between EGFR mutant group and wild group(P>0.05).Conclusion:(1)Young patients(<64 years old)with pathological type of nonsquamous cell carcinoma are independent risk factors for brain metastasis in patients with stage IIIB-IV NSCLC;From no risk factors to two risk factors,the incidence of brain metastasis increased from 11.43% to 53.62%,and high-risk groups of brain metastases can be screened early according to this result,and early intervention can be given to improve the prognosis of patients.(2)In patients with advanced NSCLC brain metastases,patients with pathological types of adenocarcinoma,non-smoking patients,and brain metastases with nodular enhancement are more likely to develop EGFR mutations,which can provide a basis for the identification of NSCLC brain metastases of different molecular classifications,and can also provide clinical basis for EGFR TKI-targeted therapy in patients who cannot be detected by EGFR.