Chen Limin, Fu Mengjiao, Zhou Jianya, Yao Yinan, Zhou Jianying
Respiratory Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
Zhongguo Fei Ai Za Zhi. 2019 May 20;22(5):312-318. doi: 10.3779/j.issn.1009-3419.2019.05.08.
Advanced epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma had a high overall incidence of brain metastasis during the full course, and local brain radiotherapy combined with systemic targeted therapy may be a better strategy. This study aimed to identify the prognostic factors of EGFR-mutant brain-metastatic lung adenocarcinoma patients who received EGFR-tyrosine kinase inhibitors (EGFR-TKIs) in combination with gamma knife radiosurgery.
Retrospective analysis of EGFR-mutant lung adenocarcinoma patients with brain metastases which developed at initial diagnosis or during EGFR-TKIs treatment period were performed. Intracranial progression free survival (PFS) was statistically analyzed between different subgroups to find out the prognostic factors including gender, age, smoking history, extracranial metastasis, EGFR mutation type, size and number of intracranial lesions, carcino-embryonic antigen (CEA) level, lung-molGPA score and so on.
A total of 74 EGFR-mutant brain-metastatic lung adenocarcinoma patients were enrolled in this study, with median intracranial PFS of 14.7 months. One-year intracranial-progression-free rate was 58.5%, and two-year rate was 22.2%. Univariate survival analysis showed that patients with lower CEA level at initial diagnosis (<10 ng/L)(16.9 months vs 12.6 months, P=0.012) and smaller intracranial lesions (<2 cm)(15.4 months vs 10.8 months, P=0.021) and higher lung-molGPA score (>3)(15 months vs 12.6 months, P=0.041) were prone to have a superior intracranial PFS. Multivariate analysis showed that CEA≥10 ng/mL and intracranial lesion≥2 cm were the independent risk factors of intracranial PFS.
EGFR-TKIs in combination with gamma knife radiosurgery was an efficient treatment option to control the cranial tumor lesion. CEA≥10 μg/L at initial diagnosis and intracranial lesion≥2 cm were the risk factors of EGFR-mutant brain-metastatic lung adenocarcinoma patients receiving EGFR-TKIs in combination with gamma knife radiosurgery.
晚期表皮生长因子受体（EGFR）突变型肺腺癌在整个病程中脑转移的总体发生率较高，局部脑放疗联合全身靶向治疗可能是更好的策略。本研究旨在确定接受EGFR酪氨酸激酶抑制剂（EGFR-TKIs）联合伽玛刀放射外科治疗的EGFR突变型脑转移肺腺癌患者的预后因素。
对初诊时或EGFR-TKIs治疗期间发生脑转移的EGFR突变型肺腺癌患者进行回顾性分析。对不同亚组的颅内无进展生存期（PFS）进行统计学分析，以找出预后因素，包括性别、年龄、吸烟史、颅外转移、EGFR突变类型、颅内病变大小和数量、癌胚抗原（CEA）水平、肺molGPA评分等。
本研究共纳入74例EGFR突变型脑转移肺腺癌患者，颅内PFS的中位数为14.7个月。1年颅内无进展率为58.5%，2年率为22.2%。单因素生存分析显示，初诊时CEA水平较低（<10 ng/L）（16.9个月对12.6个月，P=0.012）、颅内病变较小（<2 cm）（15.4个月对10.8个月，P=0.021）和肺molGPA评分较高（>3）（15个月对12.6个月，P=0.041）的患者颅内PFS较好。多因素分析显示，CEA≥10 ng/mL和颅内病变≥2 cm是颅内PFS的独立危险因素。
EGFR-TKIs联合伽玛刀放射外科是控制颅脑肿瘤病变的有效治疗选择。初诊时CEA≥10 μg/L和颅内病变≥2 cm是接受EGFR-TKIs联合伽玛刀放射外科治疗的EGFR突变型脑转移肺腺癌患者的危险因素。
