Division of Clinical Oncology, Sumitomo Besshi Hospital, 3-1 Ohji-cho, Niihama, Japan.
Lung Cancer. 2012 Jul;77(1):134-9. doi: 10.1016/j.lungcan.2012.03.002. Epub 2012 Apr 7.
We examined the prognosis of patients with leptomeningeal metastasis (LM) from non-small cell lung cancer (NSCLC) and that stratified by epidermal growth factor receptor (EGFR) mutation status in LM patients receiving EGFR-tyrosine kinase inhibitors (TKIs).
We retrospectively analyzed a series of 91 consecutive NSCLC patients with LM between 2001 and 2010.
Most of the LM patients had adenocarcinoma histology and a poor performance status (PS). The median survival time (MST) for all patients was 3.6 months. Adenocarcinoma and TKI treatment were associated with a better prognosis. Among the patients, 51 received EGFR-TKIs. Of these, the EGFR mutation status was assessed in 30 patients; 7 (23%) showed no mutation (group 1), 10 (33%) had a mutation in exon 21 (group 2), and 13 (43%) had deletions in exon 19 (group 3). Interestingly, PS was significantly improved in groups 2 and 3 but not in group 1. The MST in these subgroups was 1.4, 7.1, and 11.0 months in groups 1, 2, and 3, respectively (p<0.001). The median time to progression or symptom deterioration was 0.9, 2.0, and 7.8 months for groups 1, 2, and 3, respectively (p<0.001). A multivariate analysis showed that EGFR-mutant tumors were associated with a better prognosis in patients receiving EGFR-TKIs.
The prognosis for patients with LM from NSCLC was still poor. Survival after the initiation of EGFR-TKI treatment differed according to the type of EGFR mutation, suggesting the potential benefit of TKIs for patients with EGFR mutations, even though they suffered from LM.
我们研究了表皮生长因子受体（EGFR）突变状态分层的非小细胞肺癌（NSCLC）患者接受 EGFR 酪氨酸激酶抑制剂（TKI）治疗后合并脑膜转移（LM）患者的预后。
我们回顾性分析了 2001 年至 2010 年间连续 91 例 NSCLC 合并 LM 患者。
大多数 LM 患者为腺癌组织学和较差的表现状态（PS）。所有患者的中位生存时间（MST）为 3.6 个月。腺癌和 TKI 治疗与更好的预后相关。在这些患者中，51 例接受了 EGFR-TKIs。其中，30 例评估了 EGFR 突变状态；7 例（23%）无突变（组 1），10 例（33%）第 21 外显子突变（组 2），13 例（43%）第 19 外显子缺失（组 3）。有趣的是，组 2 和组 3 的 PS 明显改善，但组 1 无改善。这些亚组的 MST 分别为 1.4、7.1 和 11.0 个月（P<0.001）。组 1、2 和 3 的进展或症状恶化的中位时间分别为 0.9、2.0 和 7.8 个月（P<0.001）。多变量分析显示，EGFR 突变型肿瘤与接受 EGFR-TKI 治疗的患者预后较好相关。
NSCLC 合并 LM 患者的预后仍较差。EGFR-TKI 治疗开始后生存时间根据 EGFR 突变类型而不同，提示 EGFR 突变患者接受 TKI 治疗可能获益，即使他们患有 LM。
