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

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 L858R mutation (P=0.05). Compared with Exon21 L858R mutation group, the OS of patients in Exon19-del+Exon20T790M 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.