Li R, Zhang S R, Liu X F, Zhang J W, Zhao J Y, Bai P, Zhang X C
Department of Respiratory and Critical Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China.
Department of Oncology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China.
Zhonghua Yi Xue Za Zhi. 2023 Apr 25;103(16):1202-1209. doi: 10.3760/cma.j.cn112137-20221028-02243.
To investigate the prognostic factors of patients with central nervous system (CNS) metastatic non-small cell lung cancer (NSCLC) with positive driver genes. The clinical data of 103 patients with CNS metastatic NSCLC admitted to Beijing Tongren Hospital from January 2016 to December 2020 were retrospectively analyzed, and the patients were divided into positive driver gene group (patients with driver genes mutation and receiving corresponding targeted therapy) and negative driver gene group. Cox univariate and multivariate regression analyses were performed to identify the factors affecting patients' prognosis, and the receiver operating characteristic curve (ROC) was used to compare the predictive ability of 4 scoring systems [recursive partitioning analysis (RPA) classes, diagnosis-specific graded prognostic assessment (DS-GPA) index, basic score for brain metastasesn (BS-BM) and (lung-molecular graded prognostic assessment (lung-mol GPA)]on patients' prognosis. Among the 103 patients, 48 were males and 55 were females, and aged (64.6±9.7) years old. The median survival time of the 103 patients was 24.0 (95%: 20.0-28.0) months, the median survival time of the 59 patients in the positive driver gene group was 33.0 (95%: 23.4-42.6) months, the median survival time of the 44 patients in the negative driver gene group was 17.0 (95%: 14.4-19.6) months, and the difference was statistically significant (=24.69, <0.001). The results of Cox multivariate analysis showed that the negative driver genes (=3.788, 95%: 1.951-7.301, =0.001), Karnofsky performance status (KPS) score<70 (=2.613, 95%: 1.185-5.761, =0.017) and neutrophil-to-lymphocyte ratio (NLR)>3.22 (=2.714, 95%: 1.157-6.365, =0.022) were independent risk factors affecting the prognosis of patients with CNS metastatic NSCLC. KPS score<70 (=3.719, 95%: 1.165-11.876, =0.027) and no radiotherapy (=2.032, 95%: 1.033-11.364, =0.041) were independent risk factors affecting the prognosis of patients with CNS metastatic NSCLC with positive driver genes. ROC curve analysis showed that the area under curve (AUC) value of lung-mol GPA was the highest among the 4 scoring systems (AUC=0.843, 95%: 0.731-0.956, <0.001), and the AUC value of the lung-mol GPA combined scoring system (AUC=0.904, 95%: 0.816-0.991, <0.001) was higher than lung-mol GPA. A low KPS score and no cranial radiation therapy are independent risk factors for the prognosis of patients with CNS metastatic NSCLC with positive driver genes; the lung-mol GPA joint scoring system is more conducive to the prognostic assessment of patients with CNS metastatic NSCLC with positive driver genes.
探讨驱动基因阳性的中枢神经系统（CNS）转移非小细胞肺癌（NSCLC）患者的预后因素。回顾性分析2016年1月至2020年12月在北京同仁医院住院的103例CNS转移NSCLC患者的临床资料，将患者分为驱动基因阳性组（驱动基因突变并接受相应靶向治疗的患者）和驱动基因阴性组。进行Cox单因素和多因素回归分析以确定影响患者预后的因素，并采用受试者工作特征曲线（ROC）比较4种评分系统[递归划分分析（RPA）分级、诊断特异性分级预后评估（DS-GPA）指数、脑转移基本评分（BS-BM）和肺分子分级预后评估（lung-mol GPA）]对患者预后的预测能力。103例患者中，男性48例，女性55例，年龄（64.6±9.7）岁。103例患者的中位生存时间为24.0（95%：20.0 - 28.0）个月，驱动基因阳性组59例患者的中位生存时间为33.0（95%：23.4 - 42.6）个月，驱动基因阴性组44例患者的中位生存时间为17.0（95%：14.4 - 19.6）个月，差异有统计学意义（=24.69，<0.001）。Cox多因素分析结果显示，驱动基因阴性（=3.788，95%：1.951 - 7.301，=0.001）、卡氏功能状态（KPS）评分<70（=2.613，95%：1.185 - 5.761，=0.017）和中性粒细胞与淋巴细胞比值（NLR）>3.22（=2.714，95%：1.157 - 6.365，=0.022）是影响CNS转移NSCLC患者预后的独立危险因素。KPS评分<70（=3.719，95%：1.165 - 11.876，=0.027）和未行放射治疗（=2.032，95%：1.033 - 11.364，=0.041）是影响驱动基因阳性的CNS转移NSCLC患者预后的独立危险因素。ROC曲线分析显示，lung-mol GPA在4种评分系统中曲线下面积（AUC）值最高（AUC = 0.843，95%：0.731 - 0.956，<0.001），且lung-mol GPA联合评分系统的AUC值（AUC = 0.904，95%：0.816 - 0.991，<0.001）高于lung-mol GPA。低KPS评分和未行颅脑放射治疗是驱动基因阳性的CNS转移NSCLC患者预后的独立危险因素；lung-mol GPA联合评分系统更有利于驱动基因阳性的CNS转移NSCLC患者的预后评估。
