Armocida Daniele, Pesce Alessandro, Palmieri Mauro, Cofano Fabio, Palmieri Giuseppe, Cassoni Paola, Busceti Carla Letizia, Biagioni Francesca, Garbossa Diego, Fornai Francesco, Santoro Antonio, Frati Alessandro
Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, 00161 Rome, RM, Italy.
IRCCS "Neuromed", 86077 Pozzilli, IS, Italy.
J Clin Med. 2023 May 9;12(10):3372. doi: 10.3390/jcm12103372.
Brain metastases (BMs) is one of the most frequent metastatic sites for non-small-cell lung cancer (NSCLC). It is a matter of debate whether EGFR mutation in the primary tumor may be a marker for the disease course, prognosis, and diagnostic imaging of BMs, comparable to that described for primary brain tumors, such as glioblastoma (GB). This issue was investigated in the present research manuscript. We performed a retrospective study to identify the relevance of EGFR mutations and prognostic factors for diagnostic imaging, survival, and disease course within a cohort of patients affected by NSCLC-BMs. Imaging was carried out using MRI at various time intervals. The disease course was assessed using a neurological exam carried out at three-month intervals. The survival was expressed from surgical intervention. The patient cohort consisted of 81 patients. The overall survival of the cohort was 15 ± 1.7 months. EGFR mutation and ALK expression did not differ significantly for age, gender, and gross morphology of the BM. Contrariwise, the EGFR mutation was significantly associated with MRI concerning the occurrence of greater tumor (22.38 ± 21.35 cm versus 7.68 ± 6.44 cm, = 0.046) and edema volume (72.44 ± 60.71 cm versus 31.92 cm, = 0.028). In turn, the occurrence of MRI abnormalities was related to neurological symptoms assessed using the Karnofsky performance status and mostly depended on tumor-related edema ( = 0.048). However, the highest significant correlation was observed between EGFR mutation and the occurrence of seizures as the clinical onset of the neoplasm ( = 0.004). The presence of EGFR mutations significantly correlates with greater edema and mostly a higher seizure incidence of BMs from NSCLC. In contrast, EGFR mutations do not affect the patient's survival, the disease course, and focal neurological symptoms but seizures. This contrasts with the significance of EGFR in the course and prognosis of the primary tumor (NSCLC).
脑转移瘤（BMs）是非小细胞肺癌（NSCLC）最常见的转移部位之一。原发性肿瘤中的表皮生长因子受体（EGFR）突变是否可作为BMs病程、预后及诊断成像的标志物，这一问题尚存争议，这与原发性脑肿瘤（如胶质母细胞瘤，GB）中所描述的情况类似。本研究手稿对这一问题进行了调查。我们进行了一项回顾性研究，以确定在一组受NSCLC-BMs影响的患者中，EGFR突变及预后因素与诊断成像、生存及病程的相关性。在不同时间间隔使用磁共振成像（MRI）进行成像检查。每三个月进行一次神经学检查以评估病程。生存情况从手术干预开始计算。患者队列由81名患者组成。该队列的总生存期为15±1.7个月。EGFR突变和间变性淋巴瘤激酶（ALK）表达在年龄、性别和BMs的大体形态方面无显著差异。相反，就更大肿瘤的发生率（22.38±21.35立方厘米对7.68±6.44立方厘米，P = 0.046）和水肿体积（72.44±60.71立方厘米对31.92立方厘米，P = 0.028）而言，EGFR突变与MRI显著相关。反过来，MRI异常的出现与使用卡氏功能状态评估的神经症状相关，且主要取决于肿瘤相关水肿（P = 0.048）。然而，在EGFR突变与作为肿瘤临床发作的癫痫发作的发生之间观察到最高的显著相关性（P = 0.004）。EGFR突变的存在与更大的水肿显著相关，且主要与NSCLC脑转移瘤更高的癫痫发作发生率相关。相比之下，EGFR突变不影响患者的生存、病程及局灶性神经症状，但会影响癫痫发作。这与EGFR在原发性肿瘤（NSCLC）病程和预后中的意义形成对比。
