Isaka Tetsuya, Nakayama Haruhiko, Yokose Tomoyuki, Ito Hiroyuki, Miyagi Yohei, Matsuzaki Tomohiko, Nagata Masashi, Furumoto Hideyuki, Nishii Teppei, Katayama Kayoko, Yamada Kouzo, Masuda Munetaka
Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan; Department of Surgery, Yokohama City University, Yokohama, Japan.
Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Ann Thorac Surg. 2016 Dec;102(6):1821-1828. doi: 10.1016/j.athoracsur.2016.06.001. Epub 2016 Aug 20.
Advanced unresectable pulmonary adenocarcinoma with the epidermal growth factor receptor (EGFR) exon 21 L858R point mutation (Ex21) is associated with a poor prognosis. However, for early-stage resectable adenocarcinoma, Ex21 tumors have a lower-grade malignancy than exon 19 deleted (Ex19) tumors. We therefore investigated the effect of EGFR mutations on the prognosis in patients with completely resected pN1-N2 adenocarcinoma.
Five-year disease-free survival (DFS) and overall survival (OS) were analyzed in 202 pN1-N2 pulmonary adenocarcinoma patients, 100 of whom had EGFR mutations, comprising Ex21 in 41 (20.3%), Ex19 in 55 (27.2%), and Ex18 in 4 (2%).
Patients with and without EGFR mutations had similar DFS (26.2% vs 24.6%, respectively; p = 0.280) and OS (64.9% vs 54.2%, respectively; p = 0.564). Patients with Ex19 tumors had significantly better DFS (38.8% vs 11.8%, p = 0.001) and tended to have better OS (78.3% vs 48.3%, p = 0.123) than those with Ex21 tumors. For pN1, patients with Ex19 tumors had a longer disease-free interval (54.0 vs 22.3 months, p = 0.003) and median survival time (81.0 vs 50.6 months, p = 0.022) than those with Ex21 tumors. For pN2, patients with Ex19 tumors had longer disease-free interval than those with Ex21 tumors (43.6 vs 30.1 months, p = 0.109). Multivariate analysis showed Ex21 was a prognosticator of poor DFS (hazard ratio, 2.25; 95% confidence interval, 1.21 to 4.20).
For pN1-N2 pulmonary adenocarcinoma, Ex21 mutation was associated with poorer prognosis than Ex19 mutation. Thus, EGFR mutation status should be considered when predicting prognosis.
伴有表皮生长因子受体（EGFR）第21外显子L858R点突变（Ex21）的晚期不可切除肺腺癌预后较差。然而，对于早期可切除腺癌，Ex21肿瘤的恶性程度低于第19外显子缺失（Ex19）肿瘤。因此，我们研究了EGFR突变对完全切除的pN1-N2腺癌患者预后的影响。
分析了202例pN1-N2肺腺癌患者的5年无病生存期（DFS）和总生存期（OS），其中100例患者存在EGFR突变，包括41例（20.3%）Ex21、55例（27.2%）Ex19和4例（2%）Ex18。
有和没有EGFR突变的患者DFS相似（分别为26.2%和24.6%；p = 0.280），OS也相似（分别为64.9%和54.2%；p = 0.564）。Ex19肿瘤患者的DFS明显优于Ex21肿瘤患者（38.8%对11.8%，p = 0.001），OS也倾向于更好（78.3%对48.3%，p = 0.123）。对于pN1，Ex19肿瘤患者的无病间期（54.0对22.3个月，p = 0.003）和中位生存时间（81.0对50.6个月，p = 0.022）长于Ex21肿瘤患者。对于pN2，Ex19肿瘤患者的无病间期长于Ex21肿瘤患者（43.6对30.1个月，p = 0.109）。多因素分析显示Ex21是DFS不良的预后因素（风险比，2.25；95%置信区间，1.21至4.20）。
对于pN1-N2肺腺癌，Ex21突变与Ex19突变相比预后较差。因此，在预测预后时应考虑EGFR突变状态。
