Zhu Fangge, Qiu Jinming, Ye Haoyuan, Su Wenting, Wang Renxi, Fu Yi
Laboratory of Brain Disorders, Beijing Institute of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, No. 10 Xitoutiao, Beijing 100069, China.
Int J Mol Sci. 2025 Apr 9;26(8):3539. doi: 10.3390/ijms26083539.
Glioblastoma (GBM) is the most aggressive and heterogeneous neoplasm among central nervous system tumors, with a dismal prognosis and a high recurrence rate. Among the various genetic alterations found in GBM, the amplification of epidermal growth factor receptor (EGFR) and the EGFR variant III (EGFRvIII) mutation are among the most common, though their prognostic value remains controversial. This systematic review and meta-analysis aimed to provide a comprehensive evaluation of the diagnostic and prognostic significance of EGFR amplification and the EGFRvIII mutation in GBM patients, incorporating recent studies published in the past few years to offer a more complete and up-to-date analysis. An extensive search of the PubMed, Web of Science, and Scopus databases was conducted, including studies that reported on EGFR and/or the EGFRvIII mutation status with detailed survival data. A total of 32 studies with 4208 GBM patients were included. The results indicated that EGFR amplification significantly correlated with worse OS (Overall survival) (HR = 1.27, 95% CI: 1.03-1.57), suggesting that EGFR amplification is an independent prognostic marker. The prognostic value of EGFRvIII was inconclusive, with a pooled hazard ratio for overall survival of 1.13 (95% CI: 0.94-1.36), indicating no significant effect on survival in the general population. However, a subgroup analysis suggested that EGFRvIII may be associated with poorer outcomes, particularly in recurrent GBM patients, where its prognostic significance became more evident. Furthermore, subgroup analyses based on geographic region revealed significant heterogeneity in the prognostic impact of EGFR amplification across different populations. In American cohorts, EGFR amplification was strongly associated with an increased risk of mortality (HR = 1.53, 95% CI: 1.28-1.84, = 0.001), suggesting that it serves as a more reliable prognostic marker in this region. In contrast, no significant prognostic impact of EGFR amplification was observed in Asian (HR = 0.64, 95% CI: 0.35-1.17) or European (HR = 0.98, 95% CI: 0.80-1.19) populations. Overall, this study underscores the potential of EGFR amplification as a prognostic marker in GBM, while further research is needed to fully elucidate the role of the EGFRvIII mutation, particularly in specific patient subgroups. Clarifying these associations could offer important insights for targeted treatment strategies, improving patient outcomes.
胶质母细胞瘤(GBM)是中枢神经系统肿瘤中最具侵袭性和异质性的肿瘤,预后不佳且复发率高。在GBM中发现的各种基因改变中,表皮生长因子受体(EGFR)扩增和EGFR变异体III(EGFRvIII)突变最为常见,但其预后价值仍存在争议。本系统评价和荟萃分析旨在全面评估EGFR扩增和EGFRvIII突变在GBM患者中的诊断和预后意义,纳入过去几年发表的最新研究以提供更完整和最新的分析。对PubMed、Web of Science和Scopus数据库进行了广泛检索,包括报告EGFR和/或EGFRvIII突变状态及详细生存数据的研究。共纳入32项研究,涉及4208例GBM患者。结果表明,EGFR扩增与较差的总生存期(OS)显著相关(HR = 1.27,95%CI:1.03 - 1.57),提示EGFR扩增是一个独立的预后标志物。EGFRvIII的预后价值尚无定论,总生存期的合并风险比为1.13(95%CI:0.94 - 1.36),表明对一般人群的生存无显著影响。然而,亚组分析表明,EGFRvIII可能与较差的预后相关,尤其是在复发性GBM患者中,其预后意义更为明显。此外,基于地理区域的亚组分析显示,EGFR扩增在不同人群中的预后影响存在显著异质性。在美国队列中,EGFR扩增与死亡风险增加密切相关(HR = 1.53,95%CI:1.28 - 1.84,P = 0.001),表明其在该地区是一个更可靠的预后标志物。相比之下,在亚洲人群(HR = 0.64,95%CI:0.35 - 1.17)或欧洲人群(HR = 0.98,95%CI:0.80 - 1.19)中未观察到EGFR扩增有显著的预后影响。总体而言,本研究强调了EGFR扩增作为GBM预后标志物的潜力,同时需要进一步研究以充分阐明EGFRvIII突变的作用,特别是在特定患者亚组中的作用。明确这些关联可为靶向治疗策略提供重要见解,改善患者预后。