EGFR和KRAS基因状态对肺癌脑转移放疗敏感性的影响-东南大学学报医学版

EGFR和KRAS基因状态对肺癌脑转移放疗敏感性的影响

单位：广西医科大学第四附属医院肿瘤科, 广西柳州 545005

分类号：R734.2

出版年·卷·期（页码）：2016·35·第六期（947-951）

摘要：

目的：探讨表皮生长因子受体（EGFR）/KRAS基因状态与肺癌脑转移放疗敏感性的关系，选出放疗优势人群，为临床个体化治疗提供参考。方法：回顾性分析我院收治的非小细胞肺癌脑转移患者121例，所有患者接受全脑放疗[30 Gy·（10f）^-1或40 Gy·（20f）^-1]及病灶局部推量治疗[20 Gy·（10f）^-1]，评估不同基因表型对放疗敏感性及颅内疾病无进展生存期的影响。结果：121例患者中50例患者EGFR突变，10例KRAS突变，EGFR突变率为49%（50/102），KRAS突变率为16.7%（10/60）。mtEGFR患者对放疗的反应率明显高于wtEGFR（82% vs 44%，P=0.000），mtEGFR患者颅内疾病无进展生存期长于wtEGFR（14个月vs 9个月，P=0.000）。对wtEGFR组患者的KRAS基因型进行亚组分析表明，wtEGFR/mtKRAS与wtEGFR/wtKRAS两组间颅内疾病无进展生存期差异无统计学意义（P=0.188）。多因素分析显示，颅外转移病灶状态、脑转移个数、脑转移病灶大小、EGFR状态是颅内疾病无进展生存期的独立预后因素。结论：mtEGFR是非小细胞肺癌脑转移颅内疾病无进展生存期的独立预后因子，较wtEGFR、wtKRAS及mtKRAS有较高的放疗敏感性。

Objective: To study the effects of genetic alteration in epidermal growth factor receptor(EGFR) and KRAS on the radiosensitivity in patients with non-small cell lung cancer(NSCLC) with brain metastases. Methods: 121 cases of patients with NSCLC were enrolled into this study. All patients were accepted whole brain radiotherapy[30 Gy·(10f)^-1 or 40 Gy·(20f)^-1]and local brain lesions boosted by 20 Gy·(10f)^-1. The response rate(RR) and disease progression-free survival(DFS) of intracranial lesions, depending on genomic status of NSCLC were evaluated. Results: A total of 50 patients(49%, 50/102) harbored EGFR mutation(mtEGFR), and 10 patients(16.7%, 10/60) showed KRAS mutation(mtKRAS). RR and DFS were significantly higher for mtEGFR patients compared with wtEGFR patients(P=0.000). Subgroup analysis was carried out by KRAS status in wtEGFR patients, results showed that there was no difference between wtEGFR/mtKRAS patients and wtEGFR/wtKRAS patients in DFS of intracranial lesions(P=0.188). Conclusion: mtEGFR is an independent prognostic factor for DFS of intracranial lesions in NSCLC patients with brain metastases, and mtEGFR patients has higher sensitivity of radiotherapy than wtEGFR, wtKRAS and mtKRAS patients.

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