驱动基因阳性中枢神经系统转移性非小细胞肺癌患者的预后影响因素分析  

Prognostic factors for non-small cell lung cancer patients with central nervous system metastasis with positive driver genes

作　　者：李然[1] 张树荣[2] 刘晓芳[1] 张佳文 赵京阳[2] 白澎[1] 张希春[1] Li Ran;Zhang Shurong;Liu Xiaofang;Zhang Jiawen;Zhao Jingyang;Bai Peng;Zhang Xichun(Department of Respiratory and Critical Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China;Department of Oncology,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院呼吸与危重症医学科,北京100176 [2]首都医科大学附属北京同仁医院肿瘤中心,北京100176

出　　处：《中华医学杂志》2023年第16期1202-1209,共8页National Medical Journal of China

基　　金：北京市自然科学基金(7212018)

摘　　要：目的探讨驱动基因阳性中枢神经系统(CNS)转移性非小细胞肺癌(NSCLC)患者的预后影响因素。方法回顾性分析2016年1月至2020年12月北京同仁医院收治的103例伴CNS转移性NSCLC患者的临床资料,将患者分为驱动基因阳性组(驱动基因突变阳性且接受相应靶向治疗)和驱动基因阴性组。采用Cox比例风险模型筛选有统计学意义的预后因素,应用受试者工作特征(ROC)曲线比较递归分级分析(RPA)、脑转移基础(BS-BM)、特殊诊断评估预后分级(DS-GPA)及肺癌相关分子分级预后评估(lung-mol GPA)4种评分系统对驱动基因阳性患者预后的预测能力。结果103例患者中,男48例,女55例,年龄(64.6±9.7)岁。103例患者的中位生存时间为24.0(95%CI:20.0~28.0)个月,59例驱动基因阳性患者的中位生存时间为33.0(95%CI:23.4~42.6)个月,44例驱动基因阴性患者的中位生存时间为17.0(95%CI:14.4~19.6)个月,差异有统计学意义(χ^(2)=24.69,P<0.001)。驱动基因阴性(HR=3.788,95%CI:1.951~7.301,P=0.001)、卡氏功能状态(KPS)评分<70分(HR=2.613,95%CI:1.185~5.761,P=0.017)及中性粒细胞与淋巴细胞比值(NLR)>3.22(HR=2.714,95%CI:1.157~6.365,P=0.022)是CNS转移性NSCLC患者预后的危险因素。KPS评分<70分(HR=3.719,95%CI:1.165~11.876,P=0.027)及未接受放射治疗(HR=2.032,95%CI:1.033~11.364,P=0.041)是驱动基因阳性CNS转移性NSCLC患者预后的危险因素。ROC曲线分析显示,在4种评分系统中,lung-mol GPA评分系统的曲线下面积(AUC)最高(AUC=0.843,95%CI:0.731~0.956,P<0.001);而lung-mol GPA联合评分系统ROC曲线的AUC值(AUC=0.904,95%CI:0.816~0.991,P<0.001)高于lung-mol GPA评分系统。结论低KPS评分及未接受颅脑放射治疗是影响驱动基因阳性CNS转移性NSCLC患者预后的危险因素;lung-mol GPA联合评分系统更利于驱动基因阳性CNS转移性NSCLC患者的预后评估。Objective To investigate the prognostic factors of patients with central nervous system(CNS)metastatic non-small cell lung cancer(NSCLC)with positive driver genes.Methods The clinical data of 103 patients with CNS metastatic NSCLC admitted to Beijing Tongren Hospital from January 2016 to December 2020 were retrospectively analyzed,and the patients were divided into positive driver gene group(patients with driver genes mutation and receiving corresponding targeted therapy)and negative driver gene group.Cox univariate and multivariate regression analyses were performed to identify the factors affecting patients′prognosis,and the receiver operating characteristic curve(ROC)was used to compare the predictive ability of 4 scoring systems[recursive partitioning analysis(RPA)classes,diagnosis-specific graded prognostic assessment(DS-GPA)index,basic score for brain metastasesn(BS-BM)and(lung-molecular graded prognostic assessment(lung-mol GPA))]on patients′prognosis.Results Among the 103 patients,48 were males and 55 were females,and aged(64.6±9.7)years old.The median survival time of the 103 patients was 24.0(95%CI:20.0-28.0)months,the median survival time of the 59 patients in the positive driver gene group was 33.0(95%CI:23.4-42.6)months,the median survival time of the 44 patients in the negative driver gene group was 17.0(95%CI:14.4-19.6)months,and the difference was statistically significant(χ^(2)=24.69,P<0.001).The results of Cox multivariate analysis showed that the negative driver genes(HR=3.788,95%CI:1.951-7.301,P=0.001),Karnofsky performance status(KPS)score<70(HR=2.613,95%CI:1.185-5.761,P=0.017)and neutrophil-to-lymphocyte ratio(NLR)>3.22(HR=2.714,95%CI:1.157-6.365,P=0.022)were independent risk factors affecting the prognosis of patients with CNS metastatic NSCLC.KPS score<70(HR=3.719,95%CI:1.165-11.876,P=0.027)and no radiotherapy(HR=2.032,95%CI:1.033-11.364,P=0.041)were independent risk factors affecting the prognosis of patients with CNS metastatic NSCLC with positive driver genes.ROC curve analysis sh

关 键 词：癌 非小细胞肺 肿瘤转移 中枢神经系统 驱动基因 预后因素 回顾性队列研究 

分 类 号：R734.2[医药卫生—肿瘤]