非小细胞肺癌EGFR不同突变状态的脑转移发生特点及治疗

发布时间：2018-04-07 00:00

本文选题：非小细胞肺癌　切入点：脑转移　出处：《中华肿瘤防治杂志》2017年05期

【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%),P0.01。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。
[Abstract]:Objective to study the relationship between epidermal growth factor receptor (EGFR) mutation and brain metastasis in non-small cell lung cancer of non-small cell lung cancer (NSCLC).The purpose of this study was to investigate the characteristics and treatment of brain metastasis in NSCLC patients with different mutation states of EGFR.Methods the clinical data of 231 patients with NSCLC diagnosed pathologically in the Department of Oncology of the Rocket Army General Hospital of the Chinese people's Liberation Army 2009-04-01-2014-12-01 were retrospectively studied.Real-time quantitative PCR method was used to detect the mutation status of EGFR in these patients.Using 蠂 2 test to compare the difference of brain metastases in patients with different mutation status of EGFR. Kaplan-Meier method was used to analyze survival.Results the results of EGFR showed that there were 3 cases (58 / 58) and 4 cases (42 / 4) of wild type with exon 1920, exon 21 and double mutation of 19 / 21, respectively. The incidence of brain metastasis in patients with exon 19 mutation was significantly higher than that in wild type patients (P 0.04).The proportion of patients with 3 brain metastases with exon 21 mutation was significantly higher than that with wild type patients (P 0.01).In addition, the median age of brain metastasis in patients with exon 21 mutation was significantly higher than that in wild type patients aged 52 years.In patients with brain metastases with EGFR mutation, the survival time after brain metastasis was significantly longer than that in patients undergoing conventional chemotherapy (not up to 9 months) after brain metastasis, with tyrosine kinase inhibitors (TK Isa).Conclusion there is a higher incidence of brain metastasis in patients with EGFR mutation at specific locus. The number of brain metastases and age at the time of brain metastasis can improve the prognosis of patients with EGFR mutation.
【作者单位】：中国人民解放军火箭军总医院肿瘤科;
【分类号】：R734.2

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