肺腺癌中的 EGFR 突变与脑转移。

EGFR mutation and brain metastasis in pulmonary adenocarcinomas.

机构信息

*Department of Internal Medicine, Division of Hematology/Oncology †Department of Internal Medicine, Division of Pulmonology, ‡Department of Pathology, and §Department of Thoracic Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

出版信息

J Thorac Oncol. 2014 Feb;9(2):195-9. doi: 10.1097/JTO.0000000000000069.

DOI:10.1097/JTO.0000000000000069

PMID:24419416

Abstract

BACKGROUND

This study aimed to explore the potential association of mutation in the epidermal growth factor receptor (EGFR) with brain metastases in patients with pulmonary adenocarcinoma.

METHODS

We analyzed clinical data on 314 patients who were tested for EGFR mutation and underwent brain magnetic resonance imaging at diagnosis. The relationship between EGFR mutation status and brain metastases at the initial presentation was analyzed. In addition, prognostic significance of EGFR mutational status on the risk of brain metastasis was evaluated in subgroups of surgically treated patients.

RESULTS

Of the 314 patients, 138 patients (43.9%) had EGFR mutations. The frequency of EGFR mutation was statistically higher for patients with brain metastases (64.7%, brain metastases; 39.8%, no metastases; 40.2%, extracranial metastases; p = 0.005). A strong association between EGFR mutation status and brain metastasis was observed (adjusted odds ratio = 3.83, p = 0.001), whereas no association was observed between EGFR mutation status and extracranial metastases (adjusted odds ratio = 1.73, p = 0.079). In addition, the number of brain metastases was significantly correlated with the EGFR mutation status (p = 0.029). Further analysis of 133 patients treated with surgical resection showed that EGFR mutation status was a poor prognostic factor for the risk of brain metastasis (hazard ratio = 4.49, p = 0.026) after adjustment for pathologic N stage.

CONCLUSIONS

We found a significant association between EGFR mutation and risk of brain metastases at the time of diagnosis and follow-up after curative resection for pulmonary adenocarcinoma. This result indicates the distinct clinical features of EGFR-mutated tumors in terms of brain metastases.

摘要

背景

本研究旨在探讨肺腺癌患者表皮生长因子受体（EGFR）突变与脑转移的潜在关联。

方法

我们分析了 314 例接受 EGFR 突变检测并在诊断时进行脑磁共振成像的患者的临床资料。分析 EGFR 突变状态与初诊时脑转移的关系。此外，还评估了 EGFR 突变状态对手术治疗患者脑转移风险的预后意义。

结果

在 314 例患者中，138 例（43.9%）存在 EGFR 突变。脑转移患者 EGFR 突变频率明显高于无脑转移患者（64.7%，脑转移；39.8%，无脑转移；40.2%，颅外转移；p=0.005）。EGFR 突变状态与脑转移之间存在强关联（调整后的优势比=3.83，p=0.001），而 EGFR 突变状态与颅外转移之间无关联（调整后的优势比=1.73，p=0.079）。此外，脑转移的数量与 EGFR 突变状态显著相关（p=0.029）。对 133 例接受手术切除治疗的患者进行进一步分析显示，EGFR 突变状态是脑转移风险的不良预后因素（调整后的风险比=4.49，p=0.026）。