Noronha Vanita, Joshi Amit, Gokarn Anant, Sharma Vibhor, Patil Vijay, Janu Amit, Purandare Nilendu, Chougule Anuradha, Jambhekar Nirmala, Prabhash Kumar
Department of Medical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra 400012, India.
Department of Medical Oncology, Malabar Cancer Center, Moozhikkara, Kannur, Kerala 670103, India.
Chemother Res Pract. 2014;2014:856156. doi: 10.1155/2014/856156. Epub 2014 Dec 7.
Introduction. Brain metastasis is a poor prognostic marker in lung cancer. However it is not known whether amongst patients with EGFR mutation those with brain metastases have a worse outcome. Methods. We compared the survival outcomes between EGFR mutation positive patients with and without brain metastases. In this retrospective analysis of prospective database of all metastatic lung cancer patients at our centre between July 2009 and December 2012, patients were treated with either combination chemotherapy or oral TKI. All patients with brain metastases received whole brain radiation. Kaplan Meier method was used for survival analysis and compared using log rank test. Results. 101 patients with EGFR mutated, metastatic lung cancer were studied. Fourteen had brain metastases and 87 did not. The common EGFR mutations were exon 19 deletion (61.3%) and exon 21 L858R mutation (28.7%). Overall response was 64% in extracranial metastasis group as compared to 50% in brain metastasis group. There was a significant worsening of median OS in the patients with brain metastases (11.6 months) compared with only extracranial metastases (18.7 months), P = 0.029. Conclusion. Amongst patients with EGFR mutant NSCLC, the presence of brain metastases leads to a worse outcome as compared to patients with extracranial metastases alone.
引言。脑转移是肺癌预后不良的一个标志。然而，在表皮生长因子受体（EGFR）突变的患者中，有脑转移的患者预后是否更差尚不清楚。方法。我们比较了有和无脑转移的EGFR突变阳性患者的生存结果。在对2009年7月至2012年12月期间我们中心所有转移性肺癌患者的前瞻性数据库进行的这项回顾性分析中，患者接受了联合化疗或口服酪氨酸激酶抑制剂（TKI）治疗。所有有脑转移的患者均接受了全脑放疗。采用Kaplan-Meier方法进行生存分析，并使用对数秩检验进行比较。结果。对101例EGFR突变的转移性肺癌患者进行了研究。14例有脑转移，87例没有。常见的EGFR突变是19外显子缺失（61.3%）和21外显子L858R突变（28.7%）。颅外转移组的总体缓解率为64%，而脑转移组为50%。与仅有颅外转移的患者（18.7个月）相比，有脑转移的患者的中位总生存期显著缩短（11.6个月），P = 0.029。结论。在EGFR突变的非小细胞肺癌患者中，与仅有颅外转移的患者相比，有脑转移会导致更差的预后。
