1 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.
J Thorac Dis. 2014 Sep;6(9):1239-50. doi: 10.3978/j.issn.2072-1439.2014.07.33.
Non-small-cell lung cancer (NSCLC) patients harboring sensitive epidermal growth factor receptor (EGFR) mutations derive greater benefits from EGFR-tyrosine kinase inhibitors (EGFR-TKIs) than those with wild type tumors. However, whether EGFR mutation status is associated with the efficacy of cytotoxic chemotherapy or prognosis in advanced NSCLC patients remained controversial. Thus, we sought to conduct a meta-analysis to answer this question.
Electronic databases were searched for eligible literatures. The primary outcomes were objective response rate (ORR) and 6-month progression-free survival (PFS) rate. The pooled odds ratio (OR) was calculated using random-effects model. Subgroup analyses stratified by study types, EGFR mutation detection methods, chemotherapy regimens, and patient origins were proposed.
A total of 14 studies involving 1,772 advanced NSCLC patients with known EGFR mutation status who had received first-line chemotherapy were included. Patients with positive EGFR mutation had numerically higher ORR than wild type patients (36.2% vs. 30.1%) without significant differences (OR 1.24, 95% CI, 0.90 to 1.70; P=0.19). However, patients with EGFR mutants had significantly superior 6-month PFS rate than wild-type patients (58.6% vs. 47.2%; OR 1.88, 95% CI, 1.33 to 2.65; P=0.0003). Results of the subgroup analyses were concordant with the overall ones.
This comprehensive analysis revealed that advanced NSCLC patients with sensitivity EGFR mutation had higher 6-month PFS rate and potentially greater ORR compared with wild-type patients after first-line chemotherapy. It suggested that EGFR mutation status should be considered a significant factor for patient stratification in evaluating the efficacy of antitumor agents in addition to EGFR-TKIs.
与野生型肿瘤相比，携带有敏感表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者从 EGFR-酪氨酸激酶抑制剂（EGFR-TKIs）中获益更大。然而，EGFR 突变状态是否与晚期 NSCLC 患者的细胞毒性化疗疗效或预后相关仍存在争议。因此，我们旨在进行一项荟萃分析来回答这个问题。
检索电子数据库以获取合格的文献。主要结局是客观缓解率（ORR）和 6 个月无进展生存期（PFS）率。使用随机效应模型计算汇总优势比（OR）。提出了按研究类型、EGFR 突变检测方法、化疗方案和患者来源进行分层的亚组分析。
共纳入 14 项研究，涉及 1772 名已知 EGFR 突变状态并接受一线化疗的晚期 NSCLC 患者。阳性 EGFR 突变患者的 ORR 略高于野生型患者（36.2% vs. 30.1%），但无显著差异（OR 1.24，95%CI，0.90 至 1.70；P=0.19）。然而，EGFR 突变患者的 6 个月 PFS 率明显优于野生型患者（58.6% vs. 47.2%；OR 1.88，95%CI，1.33 至 2.65；P=0.0003）。亚组分析的结果与总体结果一致。
这项综合分析表明，与野生型患者相比，一线化疗后具有敏感性 EGFR 突变的晚期 NSCLC 患者具有更高的 6 个月 PFS 率和潜在更大的 ORR。这表明 EGFR 突变状态除了 EGFR-TKIs 之外，还应被视为评估抗肿瘤药物疗效时患者分层的一个重要因素。
