Takenaka Tomoyoshi, Takenoyama Mitsuhiro, Yamaguchi Masafumi, Toyozawa Ryo, Inamasu Eiko, Kojo Miyako, Toyokawa Gouji, Yoshida Tsukihisa, Shiraishi Yoshimasa, Morodomi Yosuke, Hirai Fumihiko, Taguchi Kenichi, Shimokawa Mototsugu, Seto Takashi, Ichinose Yukito
Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan.
Eur J Cardiothorac Surg. 2015 Mar;47(3):550-5. doi: 10.1093/ejcts/ezu227. Epub 2014 Jun 3.
The impact of epidermal growth factor receptor (EGFR) status and the use of EGFR-tyrosine kinase inhibitor (EGFR-TKI) therapy have not been well discussed only in recurrent non-small-cell lung cancer (NSCLC). The purpose of this study was to identify the prognostic factors associated with post-recurrence survival after surgical resection of NSCLC in terms of the EGFR mutation status and the use of EGFR-TKI therapy.
From 2000 through 2011, 1237 consecutive patients with NSCLC underwent pulmonary resection at our institution. Of these patients, 280 experienced postoperative recurrence by the end of 2012. We reviewed the cases of recurrence and analysed the predictors and length of post-recurrence survival.
The median post-recurrence survival time and the 5-year survival rate of all patients were 25 months and 20.8%, respectively. A multivariate analysis identified the Eastern Cooperative Oncology Group (ECOG) performance status (PS), brain metastasis, number of sites of recurrence and EGFR mutation status to be independent prognostic factors for post-recurrence survival. Among all cases, the median post-recurrence survival time according to the use of EGFR-TKI therapy was as follows: 49 months in the EGFR mutation-positive patients treated with EGFR-TKI therapy, 20 months in the EGFR wild or unknown cases treated with EGFR-TKI therapy and 17 months in the patients not treated with EGFR-TKI therapy. As to EGFR mutation-positive cases, the patients treated with EGFR-TKIs exhibited significantly longer post-recurrence survival time than the patients treated without EGFR-TKIs (49 vs 12 months).
It is essential for recurrent NSCLC patients to be examined for the EGFR mutation status. Patients with a positive EGFR mutation status receive significant benefits from EGFR-TKI therapy.
表皮生长因子受体（EGFR）状态及EGFR酪氨酸激酶抑制剂（EGFR-TKI）治疗的影响在复发性非小细胞肺癌（NSCLC）中尚未得到充分讨论。本研究的目的是根据EGFR突变状态和EGFR-TKI治疗的使用情况，确定NSCLC手术切除后复发后生存的预后因素。
2000年至2011年，1237例连续的NSCLC患者在我院接受了肺切除术。在这些患者中，280例在2012年底出现术后复发。我们回顾了复发病例，并分析了复发后的预测因素和生存时间。
所有患者的复发后中位生存时间和5年生存率分别为25个月和20.8%。多因素分析确定东部肿瘤协作组（ECOG）体能状态（PS）、脑转移、复发部位数量和EGFR突变状态是复发后生存的独立预后因素。在所有病例中，根据EGFR-TKI治疗的使用情况，复发后中位生存时间如下：接受EGFR-TKI治疗的EGFR突变阳性患者为49个月，接受EGFR-TKI治疗的EGFR野生型或未知病例为20个月，未接受EGFR-TKI治疗的患者为17个月。对于EGFR突变阳性病例，接受EGFR-TKIs治疗的患者复发后生存时间明显长于未接受EGFR-TKIs治疗的患者（49个月对12个月）。
对复发性NSCLC患者进行EGFR突变状态检测至关重要。EGFR突变状态阳性的患者从EGFR-TKI治疗中获益显著。
