EGFR突变的晚期肺腺癌患者EGFR-TKIs治疗过程中脑转移的危险因素分析

Risk factors for brain metastasis during the EGFR-TKIs therapy for advanced lung adenocarcinoma patients with EGFR mutations

目的 评估表皮生长因子受体(EGFR)突变的晚期肺腺癌患者酷氨酸激酶抑制剂(EGFR-TKIs)治疗过程中脑转移的危险因素研究,为临床诊治提供参考。方法 回顾性分析2018年1月至2020年1月收治的134例EGFR突变晚期肺腺癌患者的临床资料,均随访至2023年4月30日。用Kaplan-Meier法计算脑转移的累积发病率,用多因素Cox回归分析脑转移的独立危险因素。结果 34例患者(25.4%)在EGFR-TKIs治疗过程中发生脑转移。多因素分析显示年龄≤53岁(HR:2.751,95%CI:1.326~5.707;P=0.007)、血清癌胚抗原≥23 ng/mL(HR:3.197,95%CI:1.512~6.758;P=0.002)和EGFR21外显子突变(HR:2.769,95%CI:1.355~5.659;P=0.005)是发生脑转移的独立高危因素。结论 EGFR突变的晚期肺腺癌患者EGFR-TKIs治疗过程中脑转移的危险因素较多,临床上值得注意。

Objective To evaluate the risk factors for brain metastasis during the epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)therapy for advanced lung adenocarcinoma patients with EGFR mutations,thus providing references for clinical diagnosis and treatment.Methods Clinical data of 134 advanced lung adenocarcinoma patients with EGFR mutations admitted to our hospital from January 2018 to January 2020 were retrospectively analyzed.They were followed up until April 30,2023.Kaplan-Meier method was used to calculate the cumulative incidence of brain metastasis,and Cox regression was used to analyze the independent risk factors for brain metastasis.Results A total of 34 patients(34/134,25.4%)experienced brain metastasis during the EGFR-TKI therapy.Multivariate analysis showed that age≤53 years(HR:2.751,95%CI:1.326-5.707;P=0.007),serum carcinoembryonic antigen≥23ng/mL(HR:3.197,95%CI:1.512-6.758;P=0.002),and mutations in EGFR exon 21(HR:2.769,95%CI:1.355-5.659;P=0.005)were independent high-risk factors for brain metastasis in advanced lung adenocarcinoma patients.Conclusion There are many risk factors for brain metastasis during the EGFR-TKIs therapy for advanced lung adenocarcinoma patients with EGFR mutations,which should be noted in clinical practice.