晚期和转移性非小细胞肺癌的基因组改变和脑转移发生率：一项系统性回顾和Meta分析

SCI

6 July 2023

Genomic alterations and the incidence of brain metastases in advanced and metastatic non-small cell lung cancer: a systematic review and meta-analysis

（Journal of thoracic oncology；IF：20.4）

Gillespie CS, Mustafa MA, Richardson GE, Alam AM, Lee KS, Hughes DM, Escriu C, Zakaria R, Genomic alterations and the incidence of brain metastases in advanced and metastatic non-small cell lung cancer: a systematic review and meta-analysis, Journal of Thoracic

Oncology (2023), doi: https://doi.org/10.1016/j.jtho.2023.06.017.

Corresponding author: Dr R Zakaria University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE E-mail: rzakaria@liverpool.ac.uk Tel: +44 (0)151 795 4400

Background 背景

Brain metastases (BM) in patients with advanced and metastatic non-small cell lung cancer (NSCLC) are linked with poor prognosis. Identifying genomic alterations associated with BM development could influence screening and determine targeted treatment. We aimed to establish prevalence and incidence in these groups, stratified by genomic alterations.

晚期和转移性非小细胞肺癌（NSCLC）患者的脑转移（BM）与不良预后相关。识别与BM发展相关的基因组改变可能会影响其筛查并可确定靶向治疗方案。我们的目的是根据基因组改变分层，确定这些群体的患病率和发病率。

Patients and Methods 病人与方法

A PRISMA-compliant systematic review and meta-analysis was conducted (PROSPERO ID CRD42022315915). Articles published in MEDLINE, EMBASE, and Cochrane Library between January 2000-May 2022 were included. Prevalence at diagnosis, and incidence of new BM per year were obtained, including patients with EGFR, ALK, KRAS, and other alterations. Pooled incidence rates were calculated using random effects models.

我们进行了符合PRISMA的系统性回顾和Meta分析（PROSPERO ID CRD42022315915），其中囊括了2000年1月至2022年5月在MEDLINE、EMBASE和Cochrane资料库发表的文章，并获得了诊断时的患病率和每年新的BM的发生率，包括EGFR、ALK、KRAS和其他改变的患者。我们使用了随机效应模型来计算其合并的发病率。

Results 结果

Sixty-four unique articles were included (24,784 NSCLC patients with prevalence data from forty-five studies and 9,058 NSCLC patients with incidence data from forty studies). Pooled BM prevalence at diagnosis was 28.6% (45 studies, 95% Confidence Interval [CI] 26.1-31.0), and highest in patients that are ALK-positive (34.9%) or with RET-translocations (32.2%). With a median follow-up of 24 months, per-year incidence of new BM was 0.13 in the wild-type group (14 studies, 95% CI 0.11-0.16). Incidence was 0.16 in the EGFR group (16 studies, 95% CI 0.11-0.21), 0.17 in the ALK group (5 studies, 95% CI 0.10-0.27), 0.10 in the KRAS group (4 studies, 95% CI 0.06-0.17), 0.13 in the ROS1 group (3 studies, 95% CI 0.06-0.28), and 0.12 in the RET group (2 studies, 95% CI 0.08-0.17).

分析包括64篇特别的文章（来自45项研究的24784名非小细胞肺癌患者的患病率数据，来自40项研究的9058名非小细胞肺癌患者的发病率数据）。诊断时的合并BM患病率为28.6%（45项研究，95%置信区间 [CI] 26.1-31.0），ALK阳性（34.9%）或RET易位（32.2%）患者的合并BM患病率最高。平均随访24个月，野生型组新BM的每年发病率为0.13（14项研究，95% CI 0.11-0.16）。EGFR组的发病率为0.16（16项研究，95% CI 0.11-0.21），ALK组的发病率为0.17（5项研究，95% CI 0.10-0.27），KRAS组的发病率为0.10（4项研究，95% CI 0.06-0.17），ROS1组的发病率为0.13（3项研究，95% CI 0.06-0.28)。RET组的发病率为0.12（2项研究，95% CI 0.08-0.17）。

Conclusions 结论

Comprehensive meta-analysis indicates a higher prevalence and incidence of BM in patients with certain targetable genomic alterations. This supports brain imaging at staging and follow-up, and the need for targeted therapies with brain penetrance

综合Meta分析表明，在具有某些靶向基因组改变的患者中，BM的患病率和发病率较高。此研究支持了分期和随访时的大脑成像，以及脑外显率靶向治疗的必要性。

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