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伴有或不伴有驱动基因的晚期非小细胞肺癌中枢神经系统转移患者抗肿瘤治疗的预后因素及生存获益：一项中国单中心队列研究

Prognostic Factors and Survival Benefits of Antitumor Treatments for Advanced Non-Small Cell Lung Cancer Patients With Central Nervous System Metastasis With or Without Driver Genes: A Chinese Single-Center Cohort Study.

作者信息

Gao Xiaoxing, Chen Minjiang, Liu Xiaoyan, Shi Yuequan, Liang Hongge, Zhou Qing, Zhao Jing, Pan Ruili, Zhong Wei, Xu Yan, Wang Mengzhao

机构信息

Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Front Oncol. 2022 Apr 26;12:879554. doi: 10.3389/fonc.2022.879554. eCollection 2022.

DOI:10.3389/fonc.2022.879554
PMID:35558520
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9090435/
Abstract

BACKGROUND

The prognosis of non-small cell lung cancer (NSCLC) patients with central nervous system (CNS) metastasis is poor. The treatment for CNS metastasis could prolong the overall survival of NSCLC patients. We aimed to investigate the prognostic factors of Chinese NSCLC patients with CNS metastasis and the survival benefits of various treatments for CNS metastasis in NSCLC patients with or without driver genes.

METHODS

Based on the CAPTRA-Lung database, NSCLC patients with CNS metastasis admitted at the Peking Union Medical College Hospital between January 2010 and October 2018 were enrolled in the study. The prognostic factors were analyzed using univariate and multivariate Cox regression analyses.

RESULTS

Overall, 418 patients were enrolled in the study. A total of 206 patients (49.3%) had CNS metastasis with positive driver genes, while 97 patients (23.2%) had negative driver genes. The median survival time after CNS metastasis was 20.8 months. In the multivariable analysis, an Eastern Cooperative Oncology Group performance status of ≥2 (hazard ratio [HR]: 1.750, 95% confidence interval [CI]: 1.184-2.588, P=0.005), number of CNS metastases ≥5 (HR: 1.448, 95% CI: 1.084 -1.934, P=0.012), and CNS metastasis developed during treatment (HR: 1.619, 95% CI: 1.232-2.129, P=0.001) were independent risk factors for poor survival. Lung adenocarcinoma (HR: 0.490, 95% CI: 0.279-0.861, P=0.013) and driver gene positivity (HR: 0.464, 95% CI: 0.302-0.715, P=0.001) were independent predictors of prolonged survival. Radiotherapy for CNS metastasis showed a survival benefit in NSCLC patients in the entire groups (HR: 0.472, 95% CI: 0.360-0.619, P <0.001), and in patients with positive driver genes.

CONCLUSION

Performance status, number of CNS metastases, timing of CNS metastasis, histological subtype, and driver gene status are prognostic factors for NSCLC patients with CNS metastasis. Furthermore, radiotherapy improved the survival in NSCLC patients with CNS metastasis.

摘要

背景

非小细胞肺癌（NSCLC）发生中枢神经系统（CNS）转移的患者预后较差。CNS转移的治疗可延长NSCLC患者的总生存期。我们旨在研究中国NSCLC发生CNS转移患者的预后因素，以及各种治疗方法对有或无驱动基因的NSCLC发生CNS转移患者的生存获益情况。

方法

基于CAPTRA-Lung数据库，纳入2010年1月至2018年10月在北京协和医院住院治疗的发生CNS转移的NSCLC患者。采用单因素和多因素Cox回归分析对预后因素进行分析。

结果

总体而言，418例患者纳入本研究。共有206例患者（49.3%）发生CNS转移且驱动基因呈阳性，97例患者（23.2%）驱动基因呈阴性。CNS转移后的中位生存时间为20.8个月。多因素分析中，东部肿瘤协作组体能状态≥2（风险比[HR]：1.750，95%置信区间[CI]：1.184 - 2.588，P = 0.005）、CNS转移灶数量≥5个（HR：1.448，95% CI：1.084 - 1.934，P = 0.012）以及在治疗期间发生CNS转移（HR：1.619，95% CI：1.232 - 2.129，P = 0.001）是生存不良的独立危险因素。肺腺癌（HR：0.490，95% CI：0.279 - 0.861，P = 0.013）和驱动基因阳性（HR：0.464，95% CI：0.302 - 0.715，P = 0.001）是生存延长的独立预测因素。对CNS转移进行放疗在整个NSCLC患者组（HR：0.472，95% CI：0.360 - 0.619，P < 0.001）以及驱动基因阳性患者中显示出生存获益。

结论

体能状态、CNS转移灶数量、CNS转移时间、组织学亚型和驱动基因状态是NSCLC发生CNS转移患者的预后因素。此外，放疗改善了NSCLC发生CNS转移患者的生存情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/990d438e7f50/fonc-12-879554-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/3d9c71394d0d/fonc-12-879554-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/e55539db0071/fonc-12-879554-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/90767d73f0e2/fonc-12-879554-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/1a2877f8c482/fonc-12-879554-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/990d438e7f50/fonc-12-879554-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/3d9c71394d0d/fonc-12-879554-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/e55539db0071/fonc-12-879554-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/90767d73f0e2/fonc-12-879554-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/1a2877f8c482/fonc-12-879554-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c855/9090435/990d438e7f50/fonc-12-879554-g005.jpg

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