EGFR基因突变型与野生型非小细胞肺癌脑转移预后的病例对照研究

A case-control study on prognosis between EGFR gene mutant-and wild-type nonsmall cell lung cancer with brain metastasis

目的:探讨表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变与非小细胞肺癌(non-small cell lung cancer,NSCLC)伴脑转移患者预后的相关性,为改善NSCLC合并脑转移患者预后、指导个体化治疗提供临床依据。方法:回顾性分析福建省立医院2013年1月1日至2018年9月30日期间收治的88例NSCLC合并脑转移患者的临床资料,随访取得患者的死亡时间,随访截止日期为2019年10月31日。收集和分析的临床资料包括性别、年龄、吸烟史、病理类型、基因检测、治疗情况、无进展生存期(progression free survival,PFS)、总生存期(overall survival,OS)等。运用生存分析(Kaplan-Meier生存时间曲线)评价EGFR突变型患者的预后,以单因素分析(log-rank检验)预测影响EGFR-TKI治疗效果的因素。结果:88例NSCLC脑转移患者有57例为EGFR突变型,其中位PFS(MPFS)为13.0个月(95%CI:11.951~14.049),明显高于EGFR野生型患者(P=0.003),患者中位生存期(median survival time,MST)为29.0个月(95%CI:20.531~37.468),明显高于EGFR野生型(P=0.001)。EGFR突变型中,Exon19-del突变组患者较Exon21 L858R突变组患者OS有延长趋势(P=0.05),Exon19-del+Exon20T790M突变组患者OS较Exon21 L858R突变组有延长趋势(P=0.077)。结论:EGFR突变组较野生型组NSCLC脑转移患者预后相对好些,且携带19外显子单一缺失突变的患者预后最好。

Objective:To investigate the correlation between epidermal growth factor receptor(EGFR)gene mutation and prognosis of non-small cell lung cancer(NSCLC)with brain metastasis,so as to provide clinical basis for improving prognosis of NSCLC patients with brain metastasis and guiding individualized treatment.Methods:The clinical data of 88 patients with NSCLC complicated with brain metastasis admitted to Fujian Provincial Hospital from January 1,2013 to September 30,2018 were retrospectively analyzed.The time of death of the patients was obtained during follow-up,and the deadline of follow-up was October 31,2019.Clinical data collected and analyzed include gender,age,smoking history,pathological type,gene detection,treatment,progression free survival(PFS),overall survival(OS),etc.Survival analysis(Kaplan-Meier survival time curve)was used to evaluate the prognosis of EGFR mutant patients.Single factor analysis(log-rank test)was used to predict the factors affecting the treatment efficacy of EGFR-TKIs.Results:57 of 88 NSCLC patients with brain metastases were EGFR mutant.The median progression free survival(MPFS)of EGFR mutant patients was 13.0 months(95%CI:11.951-14.049),which was significantly longer than that of EGFR wild type patients(P=0.003);and the median survival time(MST)of EGFR mutant patients was 29.0 months(95%CI:20.531-37.468),which was also significantly longer than that of EGFR wild type patients(P=0.001).In EGFR mutant patients,the OS of patients with Exon19-del exon deletion was significantly longer than those with Exon21 L858 R mutation(P=0.05).Compared with Exon21 L858 R mutation group,the OS of patients in Exon19-del+Exon20 T790 M mutation group was prolonged(P=0.077).Conclusion:In NSCLC patients with brain metastasis,EGFR mutant patients has a better prognosis than wild-type patients,with the best prognosis in patients with single Exon19-deletion.