Ohtaki Yoichi, Shimizu Kimihiro, Kakegawa Seiichi, Nagashima Toshiteru, Nakano Tetsuhiro, Atsumi Jun, Enokida Yasuaki, Igai Hitoshi, Ibe Takashi, Sugano Masayuki, Kamiyoshihara Mitsuhiro, Kawashima Osamu, Kaira Kyoichi, Sunaga Noriaki, Takeyoshi Izumi
Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
Mol Clin Oncol. 2014 Mar;2(2):187-196. doi: 10.3892/mco.2013.237. Epub 2013 Dec 31.
The aim of this study was to investigate the prognosis of pulmonary adenocarcinoma patients following postoperative recurrence, according to epidermal growth factor receptor () and Kirsten rat sarcoma 2 viral oncogene homolog () gene mutation status and recurrence site. In total 58 adenocarcinoma patients with recurrence following surgical resection were retrospectively evaluated between 2002 and 2011. The patients were divided into groups according to the presence or absence of and mutations and the clinicopathological characteristics, recurrence sites and postrecurrence survival were compared. and mutations were detected in 26 (45%) and 11 patients (19%), respectively. Initial recurrence was distant in 25 (43%), local in 17 (29%) and both distant and local in 16 cases (28%). In -mutant (+) cases, bilateral/contralateral lung recurrence was a frequent finding. + cases exhibited significantly better outcomes compared to + and -- (wild-type) cases. The 2-year post-recurrence survival rates were 81, 18 and 47% in +, + and wild-type cases, respectively. The patients with distant organ recurrence exhibited significantly worse survival compared with those without distant recurrence in wild-type, but not in the + cases or the entire cohort. Multivariate analysis revealed that mutations and a number of recurrent lesions were the only statistically significant independent predictors of postrecurrence prognosis. Our results indicated distinct survival differences in recurrent adenocarcinoma patients according to driver mutations. Patients with -mutated tumors exhibited increased survival, regardless of recurrence at distant sites, whereas patients with -mutated adenocarcinoma exhibited poor outcome following postoperative recurrence. Therefore, the assessment of driver mutations is essential for predicting postrecurrence survival following surgical resection.
本研究旨在根据表皮生长因子受体（EGFR）和 Kirsten 大鼠肉瘤 2 病毒癌基因同源物（KRAS）基因突变状态及复发部位，探讨肺腺癌患者术后复发后的预后情况。2002 年至 2011 年期间，对 58 例手术切除后复发的腺癌患者进行了回顾性评估。根据是否存在 EGFR 和 KRAS 突变将患者分组，并比较其临床病理特征、复发部位及复发后的生存率。分别在 26 例（45%）和 11 例（19%）患者中检测到 EGFR 和 KRAS 突变。初始复发时远处转移 25 例（43%），局部复发 17 例（29%），远处和局部均复发 16 例（28%）。在 EGFR 突变（EGFR+）病例中，双侧/对侧肺复发较为常见。与 KRAS+和 KRAS--（野生型）病例相比，EGFR+病例的预后明显更好。EGFR+、KRAS+和野生型病例复发后 2 年生存率分别为 81%、18%和 47%。在野生型病例中，远处器官复发的患者生存率明显低于无远处复发者，但在 EGFR+病例或整个队列中并非如此。多因素分析显示，EGFR 突变和复发灶数量是复发后预后的唯一具有统计学意义的独立预测因素。我们的结果表明，根据驱动基因突变，复发腺癌患者的生存存在明显差异。EGFR 突变型肿瘤患者的生存率提高，无论是否发生远处转移，而 KRAS 突变型腺癌患者术后复发后的预后较差。因此，评估驱动基因突变对于预测手术切除后复发的生存率至关重要。
