Chemotherapy and EGFR tyrosine kinase inhibitors for treatment of brain metastases from non-small-cell lung cancer: survival analysis in 210 patients.
Chemotherapy and EGFR tyrosine kinase inhibitors for treatment of brain metastases from non-small-cell lung cancer: survival analysis in 210 patients.
复制标题
化疗和 EGFR 酪氨酸激酶抑制剂治疗非小细胞肺癌脑转移：210 名患者的生存分析。
DOI：
10.2147/ott.s52172
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发表时间：
2013
影响因子：
4
通讯作者：
Mao W
中科院分区：
文献类型：
--
作者：
Fan Y;Huang Z;Fang L;Miu L;Lin N;Gong L;Yu H;Yang H;Mao W
化疗和表皮生长因子受体(EGFR)酪氨酸激酶抑制剂在治疗非小细胞肺癌(NSCLC)脑转移患者方面存在争议。我们回顾研究了210例NSCLC脑转移患者单纯局部治疗或局部治疗联合化疗和/或EGFR酪氨酸激酶抑制剂对预后的影响。分析治疗方式、Karnofsky功能状态、年龄、原发肿瘤组织学类型、脑转移数目等因素对生存时间的影响，并评价递归分割分析和分级预后评估两种预后指标的稳健性。全身用药加局部治疗的患者中位生存期高于单纯局部治疗的患者(11个月比3个月，P=0.000)。在全身用药组中，EGFR酪氨酸激酶抑制剂的中位生存期显著长于其他类型的化疗(12个月对9个月，P=0.002)。在EGFR酪氨酸激酶抑制剂组中，携带EGFR基因突变的患者的中位生存期为20个月，而携带野生型EGFR基因的患者的中位生存期为8个月。培美曲塞的中位生存期明显高于其他化疗方案(13个月和7个月，P=0.006)。多因素分析显示，预后与治疗方式(P=0.000)、卡氏功能状态(P=0.000)、脑转移数目(P=0.001)和组织学类型(P=0.007)显著相关。在分级预后评估模型中，各亚组的生存曲线显示出明显的分离。脑转移的NSCLC患者受益于培美曲塞和/或酪氨酸激酶抑制剂的局部治疗，分级预后评估指数是一个稳健的预后评估模型。
Chemotherapy and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors are controversial in the treatment of patients with brain metastases from non-small-cell lung cancer (NSCLC). We retrospectively studied the effects of solely localized treatment or localized treatment in combination with chemotherapy and/or EGFR tyrosine kinase inhibitors on outcomes in 210 NSCLC patients with brain metastases. The effects of treatment modality, Karnofsky performance status, age, primary tumor histology, number of brain metastases, and other factors on survival time were analyzed, and the robustness of two prognostic indices, ie, recursive partitioning analysis and graded prognostic assessment, was evaluated. The median survival time in patients with systemic medication and localized treatments was higher than in those with localized treatments alone (11 versus 3 months, P=0.000). Within the systemic medication group, median survival time was significantly longer for EGFR tyrosine kinase inhibitors than for other types of chemotherapy (12 versus 9 months, P=0.002). In the EGFR tyrosine kinase inhibitor group, median survival time for patients with EGFR gene mutation was 20 months versus 8 months for those with the wild-type EGFR gene. The median survival time with pemetrexed was significantly higher than with other chemotherapies (13 versus 7 months, P=0.006). In multivariate analysis, the prognosis was significantly correlated with treatment modality (P=0.000), Karnofsky performance status (P=0.000), number of brain metastases (P=0.001), and histologic tumor type (P=0.007). In the graded prognostic assessment model, survival curves for the subgroups showed clear separations. NSCLC patients with brain metastasis benefited from pemetrexed and/or tyrosine kinase inhibitors along with localized treatments, and the graded prognostic assessment index is a robust model for prognostic evaluation.