Chang Huang-Chih, Chen Yu-Mu, Tseng Chia-Cheng, Huang Kuo-Tung, Wang Chin-Chou, Chen Yung-Che, Lai Chien-Hao, Fang Wen-Feng, Kao Hsu-Ching, Lin Meng-Chih
1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial, Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
2 Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
Tumour Biol. 2017 Mar;39(3):1010428317695939. doi: 10.1177/1010428317695939.
Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are first-choice treatments for advanced non-small-cell lung cancer patients harboring EGFR mutations. Although EGFR mutations are strongly predictive of patients' outcomes and their response to treatment with EGFR-TKIs, early failure of first-line therapy with EGFR-TKIs in patients with EGFR mutations is not rare. Besides several clinical factors influencing EGFR-TKI efficacies studied earlier such as the Eastern Cooperative Oncology Group performance status or uncommon mutation, we would like to see whether semi-quantify EGFR mutation gene expression calculated by 2 was a prognostic factor in EGFR-mutant non-small cell lung cancer patients receiving first-line EGFR-TKIs. This retrospective study reviews 926 lung cancer patients diagnosed from January 2011 to October 2013 at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. Of 224 EGFR-mutant adenocarcinoma patients, 148 patients who had 2 data were included. The best cutoff values of 2 for in-frame deletions in exon 19 (19 deletion) and a position 858 substituted from leucine (L) to an arginine (R) in exon 21 (L858R) were determined using receiver operating characteristic curves. Patients were divided into high and low 2 expression based on the above cutoff level. The best cutoff point of 2 value of 19 deletion and L858R was 31.1 and 104.7, respectively. In all, 92 (62.1%) patients showed high 2 expression and 56 patients (37.9%) low 2 expression. The mean age was 65.6 years. Progression-free survival of 19 deletion mutant patients with low versus high expression level was 17.07 versus 12.04 months (P = 0.004), respectively. Progression-free survival of L858 mutant patients was 13.75 and 7.96 months (P = 0.008), respectively. EGFR-mutant lung adenocarcinoma patients with lower EGFR gene expression had longer progression-free survival duration without interfering overall survival.
表皮生长因子受体(EGFR)-酪氨酸激酶抑制剂(TKIs)是携带EGFR突变的晚期非小细胞肺癌患者的首选治疗方法。尽管EGFR突变能强烈预测患者的预后及其对EGFR-TKIs治疗的反应,但EGFR突变患者一线EGFR-TKIs治疗早期失败的情况并不罕见。除了早期研究的一些影响EGFR-TKI疗效的临床因素,如东部肿瘤协作组体能状态或罕见突变外,我们想了解通过2计算得出的EGFR突变基因表达的半定量是否是接受一线EGFR-TKIs治疗的EGFR突变非小细胞肺癌患者的一个预后因素。这项回顾性研究回顾了2011年1月至2013年10月在台湾高雄长庚纪念医院诊断的926例肺癌患者。在224例EGFR突变腺癌患者中,纳入了148例有2数据的患者。使用受试者工作特征曲线确定外显子19框内缺失(19缺失)和外显子21中第858位从亮氨酸(L)替换为精氨酸(R)(L858R)的2的最佳截断值。根据上述截断水平将患者分为高2表达组和低2表达组。19缺失和L858R的2值的最佳截断点分别为31.1和104.7。总共有92例(62.1%)患者表现为高2表达,56例(37.9%)患者表现为低2表达。平均年龄为65.6岁。19缺失突变患者低表达水平与高表达水平的无进展生存期分别为17.07个月和12.04个月(P = 0.004)。L858突变患者的无进展生存期分别为13.75个月和7.96个月(P = 0.008)。EGFR基因表达较低的EGFR突变肺腺癌患者无进展生存期更长,且不影响总生存期。
J Huazhong Univ Sci Technolog Med Sci. 2017-12