EGFR mutation status and survival after diagnosis of brain metastasis in nonsmall cell lung cancer
EGFR mutation status and survival after diagnosis of brain metastasis in nonsmall cell lung cancer
复制标题
DOI：
10.1093/neuonc/noq076
复制
发表时间：
2010-11-01
期刊：
影响因子：
15.9
通讯作者：
Sequist, Lecia V.
中科院分区：
文献类型：
--
作者：
Eichler, April F.;Kahle, Kristopher T.;Sequist, Lecia V.
一小部分非小细胞肺癌（NSCLC）患者携带表皮生长因子受体（EGFR）突变，该突变可预测对EGFR酪氨酸激酶抑制剂（TKIs）的独特敏感性。这些患者脑转移瘤（BMs）的特征和行为尚未得到很好的描述。我们回顾了2004年8月至2008年11月在我们中心接受EGFR突变筛查的所有NSCLC患者的纵向记录，以确定其合格性，并确定了93例在其疾病过程中发生BM的患者。生存率采用Kaplan-Meier法和log-rank检验。通过Cox比例风险模型评估多变量预测因子。在93例BM患者中，41例（44%）发生EGFR突变，包括13例外显子19缺失和12例L858R突变。83%的脑转移患者最初接受全脑放射治疗，单独（53%）或联合开颅神经外科切除术（22%）或立体定向放射手术（8%）。从BM开始的中位生存期为11.7个月，EGFR突变患者的中位生存期更长（14.5个月vs 7.6个月，P = 0.09）。在多变量分析中，EGFR突变（HR: 0.50, 95% CI: 0.30-0.82）、年龄（HR: 1.03, 95% CI: 1.00-1.05）和活动性颅外疾病（HR: 3.30, 95% CI: 1.70-6.41）与生存率独立相关。在伴有脑转移的非小细胞肺癌患者中，EGFR突变状态与生存率的提高相关，与年龄、功能状态、颅外疾病状态和脑转移数量无关。
A small subset of patients with nonsmall cell lung cancer (NSCLC) harbors mutations in the epidermal growth factor receptor (EGFR) that predict unique sensitivity to EGFR tyrosine kinase inhibitors (TKIs). The characteristics and behavior of brain metastases (BMs) in these patients have not been well described. The longitudinal records of all NSCLC patients who underwent EGFR mutation screening at our center from August 2004 to November 2008 were reviewed for eligibility, and 93 patients were identified who developed BM during the course of their disease. Survival was estimated using the Kaplan-Meier method and the log-rank test. Multivariable predictors were assessed via the Cox proportional hazards model. Among the 93 patients with BM, 41 (44%) had mutations in EGFR, including 13 exon 19 deletions and 12 L858R mutations. Eighty-three percent of patients with BM were treated initially with whole brain radiation, either alone (53%) or in combination with craniotomy for neurosurgical resection (22%) or stereotactic radiosurgery (8%). Median survival from the time of BM was 11.7 months and was longer for patients with an EGFR mutation (14.5 vs 7.6 months, P = .09). On multivariable analysis, EGFR mutation (HR: 0.50, 95% CI: 0.30-0.82), age (HR: 1.03, 95% CI: 1.00-1.05), and active extracranial disease (HR: 3.30, 95% CI: 1.70-6.41) were independently associated with survival. In NSCLC patients with BM, EGFR mutation status is associated with improved survival, independent of age, functional status, extracranial disease status, and number of BMs.