目的：分析表皮生长因子受体（EGFR）突变肺腺癌引起的脑膜瘤转移（LM）患者的临床特征及其对患者生存的影响。方法：对2018年7月至2022年7月期间入住中南大学湘雅医院肿瘤科并通过细胞病理学诊断为EGFR突变肺腺癌LM的81例患者的临床病理数据进行回顾性分析，其中男性33例，女性48例。年龄范围为31至76岁，中位年龄为54岁。对所有81例患者进行了随访，中位随访时间为21.0个月（95%CI：12.5至29.5个月）。采用Kaplan-Meier方法绘制生存曲线，采用Cox比例风险回归模型分析因素对患者生存的影响。结果：在81例患者中，首次诊断肺癌与脑脊液（CSF）内LM的病理诊断之间的间隔为0-108个月，中位间隔为14个月。52例患者（64.2％）使用第三代表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs），17例患者（21.0％）使用EGFR-TKIs联合其他药物，12例患者（14.8％）接受最佳支持性治疗（BSC）。60例患者（74.1％）Kanofsky评分（KPS）小于60分，71例患者（87.7％）有脑实质转移和/或脊柱转移。22例患者（27.2％）通过硬脑膜下腔内注射使用蒲地蓝，17例患者（21.0％）通过Ommaya囊向脑室腔内注射蒲地蓝。与蒲地蓝脑脊液注射相关的不良事件的发生率为64.1％（25/39），主要表现为骨髓抑制，包括22例患者的白细胞减少，25例患者的血红蛋白减少，和14例患者的血小板减少。81例患者的脑膜瘤转移后总生存期中位数（pLM-OS）为11.0（95%CI：7.7-14.3）个月。KPS评分≥60分（HR=0.407，95%CI：0.170-0.973，P=0.043）、治疗后CSF细胞学阴性（与持续阳性相比，HR=0.351，95%CI：0.155-0.792，P=0.012）、脑室内蒲地蓝注射（与非脑室内蒲地蓝注射相比，HR=0.319，95%CI：0.137-0.745，P=0.008）和LM后使用第三代EGFR-TKIs治疗（与EGFR-TKIs联合其他药物相比，HR=0.486，95%CI：0.237-0.998，P=0.049）是影响患者pLM-OS的因素。结论：脑实质或/和脊椎是LM患者同时转移的最常见部位。KPS评分≥60分和治疗后CSF细胞学阴性、脑室内蒲地蓝注射以及使用第三代EGFR-TKIs是影响患者pLM-OS的指标。

Objective: To analyze the clinical characteristics of leptomeningeal metastasis (LM) patients from epithelial growth factor receptor (EGFR)-mutated lung adenocarcinoma, and their impacts on the survival of the patients. Methods: From July 2018 to July 2022, the clinicopathological data of 81 patients diagnosed as EGFR-mutated lung adenocarcinoma LM by cytopathology who admitted to the Department of Oncology of Xiangya Hospital of Central South University were retrospectively analyzed, including 33 males and 48 females. The age ranged from 31 to 76 years, with a median age of 54 years. All the 81 patients were followed up, with a median follow-up of 21.0 months (95%CI: 12.5 to 29.5 months). The Kaplan Meier method was used to draw survival curve. Cox proportional hazards regression model was used to analyze the impact of the factors on the survival of patients. Results: Among the 81 patients, the interval between the initial diagnosis of lung cancer and the pathological diagnosis of LM in cerebrospinal fluid (CSF) was 0-108 months, with a median interval of 14 months. Fifty-two patients (64.2%) used the third-generation epithelial growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs), while 17 patients (21.0%) used EGFR-TKIs in combination with other drugs, and 12 patients (14.8%) were treated with best supportive care (BSC). Sixty patients (74.1%) had a Kanofsky performance status (KPS) score of less than 60 points, and 71 patients (87.7%) had brain parenchymal metastasis and/or spinal metastasis. Twenty-two patients (27.2%) used pemetrexed through intrathecal CSF, and 17 patients (21.0%) used pemetrexed through the Ommaya sac to the CSF of the ventricle. The incidence of adverse event related to the administration of pemetrexed through CSF was 64.1% (25/39), mainly manifested as myelosuppression, including 22 patients of leukocyte reduction, 25 patients of hemoglobin reduction, and 14 patients of platelet reduction. The median post-leptomeningeal metastasis overall survival (pLM-OS) in 81 patients was 11.0 (95%CI: 7.7-14.3) months. KPS score≥60 points (HR=0.407, 95%CI: 0.170-0.973, P=0.043), CSF cytology negative after treatment (vs persistent positive, HR=0.351, 95%CI: 0.155-0.792, P=0.012), intraventricular administration of pemetrexed (vs non intraventricular administration of pemetrexed, HR=0.319, 95%CI: 0.137-0.745, P=0.008) and the treatment with third-generation EGFR-TKIs after LM (vs EGFR-TKIs in combination with other drugs, HR=0.486, 95%CI: 0.237-0.998, P=0.049) were a factor affecting pLM-OS of patients. Conclusions: Brain parenchyma, or/and spine are the most sites where the LM patients concurrently metastasize. KPS score≥60 points and CSF cytology negative after treatment, intraventricular administration of pemetrexed and the treatment with third-generation EGFR-TKIs are indictors affecting pLM-OS of the patients.