Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cance, Tianjin's Clinical Research Centre for Cancer, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin, 300060, PR China.
BMC Cancer. 2020 Sep 3;20(1):837. doi: 10.1186/s12885-020-07249-7.
In 1997, the Radiation Therapy Oncology Group (RTOG) put forward the recursive partitioning analysis classification for the prognosis of brain metastases (BMs), but this system does not take into account the epidermal growth factor receptor (EGFR) mutations. The aim of the study is to assess the prognosis of patients with EGFR-mutated non-small cell lung cancer (NSCLC) and BMs in the era of tyrosine kinase inhibitor (TKI) availability.
This was a retrospective study of consecutive patients with EGFR-mutated (exon 19 or 21) NSCLC diagnosed between 01/2011 and 12/2014 at the Tianjin Medical University Cancer Institute & Hospital and who were ultimately diagnosed with BMs. The patients were stage I-III at initial presentation and developed BMs as the first progression. Overall survival (OS), OS after BM diagnosis (mOS), intracranial progression-free survival (iPFS), response to treatment, and adverse reactions were analyzed.
Median survival was 35 months, and the 1- and 2- year survival rates were 95.6% (108/113) and 74.3% (84/113). The 3-month CR + PR rates of radiotherapy(R), chemotherapy(C), targeted treatment(T), and targeted treatment + radiotherapy(T+R) after BMs were 63.0% (17/27), 26.7% (4/15), 50.0% (7/14), and 89.7% (35/39), respectively. The median survival of the four treatments was 20, 9, 12, and 25 months after BMs, respectively (P = 0.001). Multivariable analysis showed that < 3 BMs (odds ratio (OR) = 3.34, 95% confidence interval (CI): 1.89-5.91, P < 0.001) and treatment after BMs (OR = 0.68, 95%CI: 0.54-0.85, P = 0.001) were independently associated with better prognosis.
The prognosis of patients with NSCLC and EGFR mutation in exon 19 or 21 after BM is associated with the number of brain metastasis and the treatment method. Targeted treatment combined with radiotherapy may have some advantages over other treatments, but further study is warranted to validate the results.
1997 年，放射治疗肿瘤学组（RTOG）提出了脑转移瘤（BMs）的预后递归分区分析分类，但该系统未考虑表皮生长因子受体（EGFR）突变。本研究旨在评估在酪氨酸激酶抑制剂（TKI）可用时代 EGFR 突变型非小细胞肺癌（NSCLC）和 BMs 患者的预后。
这是一项回顾性研究，连续纳入了 2011 年 1 月至 2014 年 12 月在天津医科大学肿瘤医院诊断为 EGFR 突变（外显子 19 或 21）的 NSCLC 并最终诊断为 BMs 的患者。这些患者在初始表现时为 I-III 期，并作为首次进展出现 BMs。分析总生存期（OS）、BM 诊断后的 OS（mOS）、颅内无进展生存期（iPFS）、治疗反应和不良反应。
中位生存期为 35 个月，1 年和 2 年生存率分别为 95.6%（108/113）和 74.3%（84/113）。BM 后放疗（R）、化疗（C）、靶向治疗（T）和靶向治疗+放疗（T+R）的 3 个月完全缓解+部分缓解（CR+PR）率分别为 63.0%（27/43）、26.7%（15/56）、50.0%（14/28）和 89.7%（39/43）。4 种治疗方法在 BMs 后分别的中位生存期为 20、9、12 和 25 个月（P=0.001）。多变量分析表明，<3 个 BMs（比值比（OR）=3.34，95%置信区间（CI）：1.89-5.91，P<0.001）和 BMs 后治疗（OR=0.68，95%CI：0.54-0.85，P=0.001）与更好的预后独立相关。
EGFR 外显子 19 或 21 突变型 NSCLC 患者出现 BMs 后的预后与脑转移瘤的数量和治疗方法有关。靶向治疗联合放疗可能比其他治疗方法具有一些优势，但需要进一步研究来验证结果。
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