Brain metastases in lung adenocarcinoma: impact of EGFR mutation status on incidence and survival.
Brain metastases in lung adenocarcinoma: impact of EGFR mutation status on incidence and survival.
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DOI：
10.2478/raon-2014-0016
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发表时间：
2014-06
影响因子：
2.4
通讯作者：
Cufer T
中科院分区：
文献类型：
--
作者：
Stanic K;Zwitter M;Hitij NT;Kern I;Sadikov A;Cufer T
脑是肺腺癌的常见进展部位。本研究旨在分析常规临床实践中表皮生长因子受体（EGFR）突变状态与脑转移（BM）频率和生存之间的关系。我们回顾性分析了斯洛文尼亚629例腺癌患者的医疗记录，这些患者进行了EGFR突变检测，以分析BM的累积发病率、从诊断到发展为BM的时间（TDBM）、从BM到死亡的时间（TTD）和中位生存期。在629例患者中，168例（27%）患有BM，其中90例患者在诊断时已经患有BM。另外78名患者在14.3个月的中位间隔后出现脑转移；EGFR阳性患者为25.8个月，EGFR阴性患者为11.8个月（p = 0.002）。47例（28%）BM患者存在EGFR突变。EGFR阳性和阴性患者的BM累积发病率曲线显示，诊断时EGFR突变患者的BM发病率有更高的趋势（19% vs. 13%, p = 0.078），但在疾病过程中没有差异。诊断为BM的患者的TTD（7.3个月）比诊断为BM的患者（3.1个月）更长。EGFR阳性BM患者诊断时的TTD长于EGFR阴性患者（12.6 vs. 6.8, p = 0.005），而EGFR状态对BM晚期患者的TTD无影响。除了EGFR阳性患者在诊断时BM的频率无显著增加外，EGFR状态对BM的累积发病率没有影响。EGFR阳性患者到中枢神经系统进展的时间较长。虽然诊断时EGFR阳性的BM患者有较长的生存期，但在病程较晚发生BM的患者中，EGFR状态对TTD没有影响。
The brain represents a frequent progression site in lung adenocarcinoma. This study was designed to analyse the association between the epidermal growth factor receptor (EGFR) mutation status and the frequency of brain metastases (BM) and survival in routine clinical practice. We retrospectively analysed the medical records of 629 patients with adenocarcinoma in Slovenia who were tested for EGFR mutations in order to analyse the cumulative incidence of BM, the time from the diagnosis to the development of BM (TDBM), the time from BM to death (TTD) and the median survival. Out of 629 patients, 168 (27%) had BM, 90 patients already at the time of diagnosis. Additional 78 patients developed BM after a median interval of 14.3 months; 25.8 months in EGFR positive and 11.8 months in EGFR negative patients, respectively (p = 0.002). EGFR mutations were present in 47 (28%) patients with BM. The curves for cumulative incidence of BM in EGFR positive and negative patients demonstrate a trend for a higher incidence of BM in EGFR mutant patients at diagnosis (19% vs. 13%, p = 0.078), but no difference later during the course of the disease. The patients with BM at diagnosis had a statistically longer TTD (7.3 months) than patients who developed BM later (3.1 months). The TTD in EGFR positive patients with BM at diagnosis was longer than in EGFR negative patients (12.6 vs. 6.8, p = 0.005), while there was no impact of EGFR status on the TTD of patients who developed BM later. Except for a non-significant increase of frequency of BM at diagnosis in EGFR positive patients, EGFR status had no influence upon the cumulative incidence of BM. EGFR positive patients had a longer time to CNS progression. While EGFR positive patients with BM at diagnosis had a longer survival, EGFR status had no influence on TTD in patients who developed BM later during the course of disease.
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