Yu Xiaoqing, Fan Yun
Department of Thoracic Medical Oncology, Zhejiang Caner Hospital, Hangzhou, 310022, Zhejiang, People's Republic of China.
Key laboratory Diagnosis and Treatment Technology on Thoracic Oncology (esophagus, lung), Zhejiang Caner Hospital, 310022, Zhejiang, People's Republic of China.
J Cancer. 2019 Jun 9;10(15):3486-3493. doi: 10.7150/jca.30292. eCollection 2019.
: With the wide application of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), the survival of EGFR-mutant non-small-cell lung cancer (NSCLC) patients with brain metastasis (BM) has been significantly improved. However, prognosis analysis for patients with EGFR mutation and BM is still lacking, and the prognostic factors remain to be determined. : A total of 746 NSCLC patients with BM were identified between January 2013 and December 2016 at our institution. Overall, 261 patients harboring EGFR mutation and meeting the inclusion criteria for the study were enrolled. Exclusion criteria included KPS<50, diagnosed with BM during treatment with EGFR-TKIs, or insufficient follow-up. Overall survival (OS) was measured from the date of brain metastases. Independent prognostic factors were confirmed using a Cox regression model. : The median follow-up time for these patients was 32.7 months (95% CI, 23.5-41.9). The median OS after development of brain metastases was 23.0 months (95% CI, 20.01-25.99). By univariate analysis, significantly shorter OS was noted in patients older than 65 years (p=0.025), KPS <70 (p=0.003), presence of extracranial metastases (ECM) (p=0.00), without intracranial local treatment (p=0.000), and without chemotherapy (p=0.001). There was no difference in OS with respect to EGFR mutation type and number of BM (p=0.343, p=0.729, respectively). The Cox proportional hazards regression model revealed that performance status (KPS<70, p=0.010), ECM (p=0.001), receiving intracranial local treatment (p=0.005) and chemotherapy (p=0.005) were independent prognostic factors for OS, while age was not (p=0.087). Patients with higher diagnosis-specific graded prognostic assessment (DS-GPA) and Lung-molGPA scores corresponded to better prognosis (p=0.000). : This retrospective analysis demonstrated that performance status (KPS≥70), absence of ECM metastases, administration of local treatment and chemotherapy were associated with superior OS in patients with EGFR-mutant NSCLC who developed BM. The DS-GPA and Lung-molGPA indexes still applied to NSCLC patients with mutant genotypes and BM.
随着表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）的广泛应用，表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）脑转移（BM）患者的生存期得到了显著改善。然而，对于EGFR突变合并BM患者的预后分析仍然缺乏，预后因素尚待确定。
2013年1月至2016年12月期间，在我们机构共识别出746例NSCLC脑转移患者。总体而言，261例携带EGFR突变且符合研究纳入标准的患者被纳入研究。排除标准包括KPS<50、在接受EGFR-TKIs治疗期间被诊断为BM或随访不足。总生存期（OS）从脑转移日期开始计算。使用Cox回归模型确定独立预后因素。
这些患者的中位随访时间为32.7个月（95%CI，23.5-41.9）。脑转移发生后的中位OS为23.0个月（95%CI，20.01-25.99）。单因素分析显示，年龄大于65岁（p=0.025）、KPS<70（p=0.003）、存在颅外转移（ECM）（p=0.00）、未接受颅内局部治疗（p=0.000）以及未接受化疗（p=0.001）的患者OS显著缩短。EGFR突变类型和BM数量对OS无差异（分别为p=0.343，p=0.729）。Cox比例风险回归模型显示，体能状态（KPS<70，p=0.010）、ECM（p=0.001）、接受颅内局部治疗（p=0.005）和化疗（p=0.005）是OS的独立预后因素，而年龄不是（p=0.087）。诊断特异性分级预后评估（DS-GPA）和Lung-molGPA评分较高的患者预后较好（p=0.000）。
这项回顾性分析表明，体能状态（KPS≥70）、无ECM转移、进行局部治疗和化疗与发生BM的EGFR突变NSCLC患者的OS改善相关。DS-GPA和Lung-molGPA指数仍然适用于具有突变基因型和BM的NSCLC患者。
