Wu Yingxi, Zhao Yuhua, Wu Yufeng, Chen Haiyang, Ma Shuxiang, Wang Qiming
Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China; Institute of Cancer Research, Henan Academy of Innovations in Medical Science, Zhengzhou, China.
Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China; Institute of Cancer Research, Henan Academy of Innovations in Medical Science, Zhengzhou, China.
Clin Lung Cancer. 2024 Jun;25(4):347-353.e1. doi: 10.1016/j.cllc.2024.02.001. Epub 2024 Feb 8.
To analyze the factors associated with EGFR-mutated lung cancer with leptomeningeal metastasis (LM) in the real world that affects the prognosis of patients.
The clinical data of 123 patients with advanced EGFR mutated lung cancer combined with LM treated at Henan Cancer Hospital and confirmed by histology between January 2016 and December 2020 were retrospectively collected, and all patients were followed up until September 2021. Analyze the median overall survival (mOS) time of patients with clinical characteristics and treatment factors to explore the factors influencing the prognosis of lung cancer patients with LM.
A total of 123 patients with EGFR-mutated lung cancer and LM were included in this study. Overall, patients with exon 19 deletion (19del) in the classical mutation of the EGFR gene had a prolonged mOS compared to patients with exon 21 L858R mutation (21L858R) (30.1 months vs. 26.0 months); patients with primary LM (mOS 21.2 months) had a significantly shorter mOS than those with secondary LM (mOS 28.3 months); mOS was also significantly shorter in patients with combined brain metastases (mOS of 25.4 months) than in patients without combined brain metastases (mOS of 33.4 months); Patients treated with tyrosine kinase inhibitors (TKI) combined with antiangiogenic therapy (bevacizumab) experienced delayed onset of LM (mOS1: 19.4 months vs. 13.9 months), and prolonged survival after LM compared with those treated with EGFR-TKI alone (mOS2: 14.5 months vs. 10.0 months); There is no survival benefit to the patients treated with EGFR-TKI combined with chemotherapy compared to the patients treated with EGFR-TKI alone.
Among NSCLC-LM patients with EGFR mutation, receiving EGFR-TKI combined with antiangiogenic therapy may result in a better survival benefit. The factors of primary LM, combined brain metastasis may be prognostic factors for poor OS.
分析现实世界中影响表皮生长因子受体（EGFR）突变型肺癌合并软脑膜转移（LM）患者预后的相关因素。
回顾性收集2016年1月至2020年12月在河南省肿瘤医院接受治疗且经组织学确诊的123例晚期EGFR突变型肺癌合并LM患者的临床资料，所有患者随访至2021年9月。分析患者临床特征及治疗因素的中位总生存期（mOS）时间，以探究影响LM肺癌患者预后的因素。
本研究共纳入123例EGFR突变型肺癌合并LM患者。总体而言，EGFR基因经典突变中19外显子缺失（19del）的患者mOS较21外显子L858R突变（21L858R）的患者延长（30.1个月 vs. 26.0个月）；原发性LM患者（mOS 21.2个月）的mOS显著短于继发性LM患者（mOS 28.3个月）；合并脑转移患者的mOS（25.4个月）也显著短于未合并脑转移患者（mOS 33.4个月）；接受酪氨酸激酶抑制剂（TKI）联合抗血管生成治疗（贝伐单抗）的患者LM发病延迟（mOS1：19.4个月 vs. 13.9个月），且与单纯接受EGFR-TKI治疗的患者相比，LM后的生存期延长（mOS2：14.5个月 vs. 10.0个月）；与单纯接受EGFR-TKI治疗的患者相比，接受EGFR-TKI联合化疗的患者未获得生存获益。
在EGFR突变的非小细胞肺癌-LM患者中，接受EGFR-TKI联合抗血管生成治疗可能带来更好的生存获益。原发性LM、合并脑转移因素可能是总生存期较差的预后因素。
