EP1.14-03 Driver Genes as Predictive Indicators of Brain Metastasis in Patients with Advanced NSCLC: EGFR and ALK as Well as RET Gene Mutations

Abstract

Brain metastasis is a cause of disease progression and death in lung cancer patients, and is also one of the most common metastatic sites of lung cancer. Non-small lung cancer (NSCLC) accounts for about 80% of all lung cancer patients, and adenocarcinoma has become the main subtype of NSCLC in recent years. A retrospective analysis verified the role of gene mutations in brain metastasis in patients with non-small lung cancer (NSCLC). The clinicopathological data of 552 patients who received driver genes detection for lung cancer in the Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital from January 2015 to June 2017 were collected; NGS was used for gene detection. The driving genes for detection were EGFR, ALK, KRAS, ROS-1, BRAF, ERBB2, RET and c-MET, which were eight lung cancer driving genes recommended in NCCN guidelines. All the tests were carried out in the Center of Molecular Pathology in the Affiliated Tumor Hospital of Zhengzhou University. Of the 552 patients with advanced NSCLC, 153 (27.7%) had brain metastases. Univariate analysis showed that age (P = 0.008), gender (P = 0.016), smoking history (P = 0.010), lymph node metastasis (P = 0.003), and three driver genes: positive EGFR mutation (P = 0.001), positive ALK gene fusion (P = 0.021) and positive RET gene fusion (P = 0.003) were factors influencing the incidence of brain metastasis. Logistic multivariate regression analysis revealed that only positive EGFR mutation (P = 0.012), positive ALK gene fusion (P = 0.015), positive RET gene fusion (P = 0.003), pathological type (P = 0.009), lymph node N2–3 metastasis (P = 0.000) and a younger age (P = 0.000) were independent risk factors for brain metastasis. In addition, a ROC curve was plotted with the above factors with AUC=0.705 (P=0.000). EGFR mutation, ALK gene fusion and RET gene fusion in advanced NSCLC patients play roles in brain metastasis as positive driver genes.