肺腺癌中的脑转移：EGFR 突变状态对发病率和生存的影响。
Brain metastases in lung adenocarcinoma: impact of EGFR mutation status on incidence and survival.
机构信息
Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia ; Faculty of Medicine, University of Maribor, Slovenia.
出版信息
Radiol Oncol. 2014 Apr 25;48(2):173-83. doi: 10.2478/raon-2014-0016. eCollection 2014 Jun.
BACKGROUND
The brain represents a frequent progression site in lung adenocarcinoma. This study was designed to analyse the association between the epidermal growth factor receptor (EGFR) mutation status and the frequency of brain metastases (BM) and survival in routine clinical practice.
PATIENTS AND METHODS
We retrospectively analysed the medical records of 629 patients with adenocarcinoma in Slovenia who were tested for EGFR mutations in order to analyse the cumulative incidence of BM, the time from the diagnosis to the development of BM (TDBM), the time from BM to death (TTD) and the median survival.
RESULTS
Out of 629 patients, 168 (27%) had BM, 90 patients already at the time of diagnosis. Additional 78 patients developed BM after a median interval of 14.3 months; 25.8 months in EGFR positive and 11.8 months in EGFR negative patients, respectively (p = 0.002). EGFR mutations were present in 47 (28%) patients with BM. The curves for cumulative incidence of BM in EGFR positive and negative patients demonstrate a trend for a higher incidence of BM in EGFR mutant patients at diagnosis (19% vs. 13%, p = 0.078), but no difference later during the course of the disease. The patients with BM at diagnosis had a statistically longer TTD (7.3 months) than patients who developed BM later (3.1 months). The TTD in EGFR positive patients with BM at diagnosis was longer than in EGFR negative patients (12.6 vs. 6.8, p = 0.005), while there was no impact of EGFR status on the TTD of patients who developed BM later.
CONCLUSIONS
Except for a non-significant increase of frequency of BM at diagnosis in EGFR positive patients, EGFR status had no influence upon the cumulative incidence of BM. EGFR positive patients had a longer time to CNS progression. While EGFR positive patients with BM at diagnosis had a longer survival, EGFR status had no influence on TTD in patients who developed BM later during the course of disease.
背景
脑是肺腺癌常见的进展部位。本研究旨在分析表皮生长因子受体（EGFR）突变状态与脑转移（BM）频率和生存的关系。
方法
我们回顾性分析了 629 名在斯洛文尼亚接受 EGFR 突变检测的腺癌患者的病历，以分析 BM 的累积发生率、从诊断到 BM 发展的时间（TDBM）、从 BM 到死亡的时间（TTD）和中位生存时间。
结果
629 例患者中，168 例（27%）有 BM，90 例患者在诊断时已有 BM。其余 78 例患者在中位间隔 14.3 个月后发展为 BM；EGFR 阳性患者为 25.8 个月，EGFR 阴性患者为 11.8 个月（p = 0.002）。有 BM 的 47 例（28%）患者存在 EGFR 突变。EGFR 阳性和阴性患者的 BM 累积发生率曲线显示，EGFR 突变患者在诊断时 BM 发生率较高（19% vs. 13%，p = 0.078），但在疾病过程中无差异。在诊断时有 BM 的患者 TTD 明显较长（7.3 个月），而后来发生 BM 的患者 TTD 较短（3.1 个月）。在诊断时有 BM 的 EGFR 阳性患者 TTD 长于 EGFR 阴性患者（12.6 比 6.8，p = 0.005），而 EGFR 状态对后来发生 BM 的患者 TTD 无影响。
结论
除了 EGFR 阳性患者诊断时 BM 频率略有增加外，EGFR 状态对 BM 的累积发生率无影响。EGFR 阳性患者有更长的 CNS 进展时间。虽然在诊断时有 BM 的 EGFR 阳性患者生存时间更长，但 EGFR 状态对疾病过程中后来发生 BM 的患者的 TTD 无影响。
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