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背景与目的全脑放疗(whole brain radiotherapy,WBRT)在表皮生长因子受体(epidermal growth factor receptor,EGFR)突变的非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移患者治疗中何时应用尚无高级别的循证医学证据。本研究旨在探讨WBRT的参与时间对携有EGFR突变的NSCLC脑转移患者生存的影响。方法 2009年8月-2015年5月在我院确诊的EGFR突变伴脑转移的晚期NSCLC共78例患者,均接受WBRT及EGFR酪氨酸激酶抑制剂(EGFR tyrosine kinase inhibitors,EGFR-TKIs)治疗的48例初治患者进入临床分析,采用Cox比例风险模型分析患者颅内无进展生存期(progression-free survival,PFS)及总生存期(overall survival,OS)的影响因素。结果全组患者颅内客观缓解率(objective response rate,ORR)为81.3%,颅内疾病控制率(disease control rate,DCR)为93.8%,中位颅内PFS为10个月,中位OS为18个月。颅内PFS的多因素分析显示,美国东部肿瘤协作组评分(Eastern Cooperative Oncology Group performance status,ECOG PS)0分-1分(HR=30.436,95%CI:4.721-196.211,P<0.001)及早期WBRT患者(HR=3.663,95%CI:1.657-8.098,P=0.001)的颅内PFS更佳。OS的多因素分析显示,ECOG PS 0分-1分(HR=57.607,95%CI:6.135-540.953,P<0.001)、早期WBRT(HR=2.757,95%CI:1.140-6.669,P=0.024)及立体定向放射外科(stereotaxic radio surgery,SRS)的应用(HR=5.964,95%CI:1.895-18.767,P=0.002)是患者OS的独立预后因素。结论早期WBRT联合TKIs治疗可改善EGFR突变的NSCLC脑转移患者的预后,尚有待大样本的前瞻性临床试验验证。
BACKGROUND & AIM: WHEN WHEN WHOLE BRAIN RADIOACTIVE TREATMENT (WBRT) IS TREATED IN PATIENTS WITH NON-SMALL CELL LUNG CANCER (NSCLC) BRAIN TRANSFER BY EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) There is no high level of evidence-based medical application yet. This study was designed to investigate the impact of WBRT on the survival of NSCLC patients with EGFR mutation. Methods A total of 78 patients with advanced NSCLC diagnosed with EGFR mutation and brain metastasis in our hospital from August 2009 to May 2015 were treated with WBRT and EGFR tyrosine kinase inhibitors (EGFR-TKIs) 48 patients with newly diagnosed patients were enrolled in the clinical analysis. The Cox proportional hazards model was used to analyze the influencing factors of progression-free survival (PFS) and overall survival (OS). Results The objective response rate (ORR) of all patients was 81.3%, the control rate of intracranial disease was 93.8%, the median intracranial PFS was 10 months, and the median OS was 18 months. Multivariate analysis of intracranial PFS showed that Eastern Cooperative Oncology Group performance status (ECOG PS) score of 0-1 points (HR = 30.436, 95% CI: 4.721-196.211, P <0.001) and early stage Patients with WBRT (HR = 3.663, 95% CI: 1.657-8.098, P = 0.001) had better intracranial PFS. OS multivariate analysis showed that ECOG PS score was -1 (HR = 57.607, 95% CI: 6.135-540.953, P <0.001), early WBRT (HR = 2.757, 95% CI: 1.140-6.669, P = 0.024 ) And stereotaxic radio surgery (SRS) (HR = 5.964, 95% CI: 1.895-18.767, P = 0.002) were independent prognostic factors in patients with OS. Conclusion The early WBRT combined with TKIs treatment can improve the prognosis of patients with EGFR-mutated NSCLC brain metastases, yet a large sample of prospective clinical trials have yet to be validated.