非小细胞肺癌EGFR不同突变状态的脑转移发生特点及治疗  

Characteristics and treatment of brain metastasis in non-small cell lung cancer patients with different epidermal growth factor receptor mutation status

作　　者：李博[1] 孙锁柱[1] 陈秀丽[1] 李朝霞[1] 王西凡 徐伟[1] 陈火明[1] 

机构地区：[1]中国人民解放军火箭军总医院肿瘤科,北京100088

出　　处：《中华肿瘤防治杂志》2017年第5期328-331,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的有研究显示,表皮生长因子受体(epidermal growth factor receptor,EGFR)的突变状态,与非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移存在相关性。本研究进一步探讨EGFR不同突变状态的NSCLC患者,脑转移发生的特点以及相应的治疗。方法选取2009-04-01-2014-12-01中国人民解放军火箭军总医院肿瘤科病理确诊断的231例NSCLC患者的临床资料,进行回顾性研究。并应用实时定量PCR方法,检测上述患者的EGFR突变状态。利用χ~2检验比较EGFR不同突变状态的患者,脑转移特点的差异。Kaplan-Meier法进行生存分析。结果 EGFR检测结果示野生型119例,18、19、20、21号外显子及19/21双突变的分别有3例、58例、5例、42例和4例。19号外显子突变患者的脑转移发生率(55.2%)显著高于野生型患者(41.2%),P=0.04。伴21号外显子突变>3个脑转移病灶患者(47.6%)的比例显著高于野生型患者(28.6%),P<0.01。此外,伴21号外显子突变患者的中位脑转移年龄(63岁)也显著高于野生型患者(52岁),P=0.02。对于伴有EGFR突变的脑转移患者,脑转移后接受过酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKIs)的患者,其中位脑转移后生存期显著长于接受常规化疗的患者(未达到vs 9个月),P=0.01。结论伴EGFR特定位点突变的患者有更高的脑转移发生率、脑转移数目及脑转移时年龄。TKIs可改善伴EGFR突变脑转移患者的预后。OBJECTIVE Results from some studies showed that there was a correlation between epidermal growth factor receptor （EGFR） mutation status and risk of brain metastasis （BM） in patients with non-small cell lung cancer. Our study explored the characteristics of BM in NSCLC patients with different epidermal growth factor receptor （EGFR） mutation status and optimal treatment. METHODS A retrospective study was conducted in 231 pathological confirmed NSCLC patients who were diagnosed between April 1st 2009 to December 1st 2014. EGFR mutation was tested by real- time polymerase chain reaction system. χ^2 test was used to compare the characteristics between EGFR statuses. RE- SULTS One hundred and nineteen patients had wild-type EGFR. And mutations at exon 18, 19, 20, 21 and 19/21 duel mutations were detected in 3, 58, 5, 42 and 4 patients, respectively. Compared with those with wild-type EGFR, patients with mutation at exon 19 had significantly higher incidence of BM （55.2% vs 41.2%, P = 0.04）. Significantly higher proportion of patients with mutation at exon 21 had more than 3 intracranial lesions compared with those with wildtype EGFR （47.6% vs 28.6%, P〈0.01）. The median age at the time of BM in patients with mutation at exon 21 was significantly older than those with wild-type EGFR （63 years vs 52 years, P=0.02）. In BM patients with EGFR muta- tion, those receiving tyrosine kinase inhibitors （TKIs） as post-BM systemic regimen had significantly longer post-BM survival than those receiving conventional chemotherapy （Not reached vs 9 months, P = 0.01）. CONCLUSIONS NSCLC patients with EGFR mutation at certain exon had significantly higher incidence of BM, significantly higher number of intracranial lesions and significantly older age at the time of BM. TKIs could significantly improve the prognosis of pa- tients with EGFR mutations.

关 键 词：非小细胞肺癌 脑转移 表皮生长因子受体 酪氨酸激酶抑制剂 

分 类 号：R734.2[医药卫生—肿瘤]