New prognostic system specific for epidermal growth factor receptor-mutated lung cancer brain metastasis

Frontiers in Oncology

Oncology

Ting-ting Ni¹  Kai-Liang Wu¹  Xing-Wen Fan¹  Ya-qi Li¹  Chao-Yang Wu²  Lu Sun²  Li-Hua Zhu³ 

[1] Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China;Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China;Department of Radiation Oncology, The People’s Hospital Affiliated to Jiangsu University, Zhenjiang, China;Department of Radiation Oncology, The People’s Hospital Affiliated to Jiangsu University, Zhenjiang, China;Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China;Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China;

关键词: EGFR;    lung cancer;    brain metastases;    TKI;    radiotherapy;   

DOI  :  10.3389/fonc.2023.1093084

 received in 2022-11-08, accepted in 2023-03-02,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionBrain metastases (BM) from lung cancer are heterogeneous, and accurate prognosis is required for effective treatment strategies. This study aimed to identify prognostic factors and develop a prognostic system exclusively for epidermal growth factor receptor (EGFR)-mutated lung cancer BM.MethodsIn total, 173 patients with EGFR-mutated lung cancer from two hospitals who developed BM and received tyrosine kinase inhibitor (TKI) and brain radiation therapy (RT) were included. Univariate and multivariate analyses were performed to identify significant EGFR-mutated BM prognostic factors to construct a new EGFR recursive partitioning analysis (RPA) prognostic index. The predictive discrimination of five prognostic scoring systems including RPA, diagnosis-specific prognostic factors indexes (DS-GPA), basic score for brain metastases (BS-BM), lung cancer using molecular markers (lung-mol GPA) and EGFR-RPA were analyzed using log-rank test, concordance index (C-index), and receiver operating characteristic curve (ROC). The potential predictive factors in the multivariable analysis to construct a prognostic index included Karnofsky performance status, BM at initial lung cancer diagnosis, BM progression after TKI, EGFR mutation type, uncontrolled primary tumors, and number of BM.Results and discussionIn the log-rank test, indices of RPA, DS-GPA, lung-mol GPA, BS-BM, and EGFR-RPA were all significant predictors of overall survival (OS) (p ≤ 0.05). The C-indices of each prognostic score were 0.603, 0.569, 0.613, 0.595, and 0.671, respectively; The area under the curve (AUC) values predicting 1-year OS were 0.565 (p=0.215), 0.572 (p=0.174), 0.641 (p=0.007), 0.585 (p=0.106), and 0.781 (p=0.000), respectively. Furthermore, EGFR-RPA performed better in terms of calibration than other prognostic indices.BM progression after TKI and EGFR mutation type were specific prognostic factors for EGFR-mutated lung cancer BM. EGFR-RPA was more precise than other models, and useful for personal treatment.

【 授权许可】

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Copyright © 2023 Zhu, Fan, Sun, Ni, Li, Wu and Wu