目的:表皮生长因子受体(EGFR)突变是非小细胞肺癌(NSCLC)患者生存的积极预后因素。在这样的病人中,脑转移意味着阴性结果。正在研究可能受益于神经外科手术的NSCLC脑转移患者。我们的目的是研究不同突变位点在手术治疗的NSCLC脑转移患者中的影响。
方法:这项回顾性队列研究包括接受脑损害切除术的NSCLC脑转移患者,其次是放疗和化疗或靶向治疗。在EGFR突变型和野生型组之间比较了人口统计学和肿瘤特征。采用logrank和Cox回归方法分析患者术后生存和危险因素。
结果:总体而言,包括101名患者,57属于EGFR突变型组,44属于EGFR野生型组。整个队列的中位术后生存期为17个月,EGFR突变型和野生型患者的持续时间为19和14个月(p=0.013),分别。多因素分析显示,外显子19del(p=0.02)和高Karnofsky性能量表评分(p<0.01)是预测生存的独立阳性预后因素。脑转移的发生时间或颅内转移的位置与EGFR突变无关。
结论:EGFR突变与适合手术治疗的NSCLC脑转移患者更好的生存结果相关。该优点归因于具有外显子19缺失的特定突变的患者。
OBJECTIVE: Epidermal growth factor receptor (EGFR) mutation is a positive prognostic factor for survival in patients with non-small-cell lung cancer (NSCLC). In such patients, brain metastasis signifies negative outcomes. Patients with NSCLC brain metastasis that may benefit from neurosurgery is under investigation. We aim to investigate the impact of different mutation loci in surgically treated NSCLC brain metastasis patients.
METHODS: This retrospective cohort study included patients with NSCLC brain metastasis who underwent brain lesionectomy, followed by radiotherapy and chemotherapy or targeted therapy. Demographics and tumor characteristics were compared between the EGFR mutant type and wild type groups. Postoperative survival and risk factors were analyzed using log rank and Cox regression methods.
RESULTS: Overall, 101 patients were included, with 57 belonging to the EGFR mutant type group and 44 to the EGFR wild type group. The median postoperative survival was 17 months for the entire cohort, with the duration being 19 and 14 months for EGFR mutant type and wild type patients (p = 0.013), respectively. Multivariate analysis revealed that exon 19 del (p = 0.02) and a high Karnofsky Performance Scale score (p < 0.01) were independent positive prognostic factors to predict survival. The timing of development of the brain metastasis or the location of the intracranial metastasis was not associated with EGFR mutations.
CONCLUSIONS: EGFR mutations are associated with better survival outcomes in patients with NSCLC brain metastasis suitable for surgical treatment. This advantage was attributed to patients having a specific mutation of exon 19 deletion.