Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Respiratory Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China.
Clin Lung Cancer. 2017 Nov;18(6):631-639.e2. doi: 10.1016/j.cllc.2017.04.015. Epub 2017 May 5.
The risk factors for liver metastasis (LM) in patients with non-small-cell lung cancer (NSCLC) remain unknown. Whether LM predicts for the effect of first-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in patients with EGFR-mutant NSCLC needs to be explored.
A total of 598 NSCLC patients from 3 centers underwent EGFR testing, and 293 had EGFR-mutant NSCLC. Of the 598 NSCLC patients, 99 had LM; 56 patients with EGFR-mutant NSCLC received EGFR-TKIs as first-line therapy.
EGFR mutation was not associated with LM in NSCLC patients (relative ratio, 1.305, P = .261). In the EGFR-mutant group that received first-line EGFR-TKIs, patients with LM had shorter progression-free survival (PFS; 7.5 vs. 11.8 months; P = .0003) and overall survival (OS; 20.8 vs. 30.6 months; P = .0190) than patients without LM. The significant difference in PFS was observed in both patients with EGFR exon 19 deletion (19del) and Leu858Arg mutation (L858R). However, patients with EGFR 19del and LM showed marginally significantly shorter OS (P = .0531) and patients with EGFR L858R and LM had OS similar to that of patients without LM (P = .1883). Regardless of EGFR status, patients with LM who received first-line chemotherapy had PFS and OS similar to those of patients without LM. Univariate analyses identified only never smoking (hazard ratio, 0.536; P = .012) was significantly associated with better OS for patients with NSCLC and LM.
EGFR mutation is not an independent risk factor for LM in NSCLC patients. However, the presence of LM is a negative predictive factor for first-line EGFR-TKI therapy for patients with EGFR-mutant NSCLC.
非小细胞肺癌（NSCLC）患者发生肝转移（LM）的危险因素尚不清楚。LM 是否可预测 EGFR 突变型 NSCLC 患者一线表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKI）的疗效，尚需进一步探讨。
共纳入来自 3 家中心的 598 例 NSCLC 患者，其中 293 例为 EGFR 突变型 NSCLC。598 例 NSCLC 患者中 99 例发生 LM；56 例 EGFR 突变型 NSCLC 患者接受 EGFR-TKI 作为一线治疗。
在 NSCLC 患者中，EGFR 突变与 LM 无关（相对比，1.305，P=.261）。在接受一线 EGFR-TKI 治疗的 EGFR 突变型患者中，LM 患者的无进展生存期（PFS；7.5 个月 vs. 11.8 个月；P=.0003）和总生存期（OS；20.8 个月 vs. 30.6 个月；P=.0190）更短。在 EGFR 外显子 19 缺失（19del）和 Leu858Arg 突变（L858R）患者中，PFS 均存在显著差异。然而，EGFR 19del 合并 LM 的患者 OS 显著缩短（P=.0531），而 EGFR L858R 合并 LM 的患者与无 LM 的患者 OS 相似（P=.1883）。无论 EGFR 状态如何，LM 患者接受一线化疗的 PFS 和 OS 与无 LM 的患者相似。单因素分析仅发现从不吸烟（危险比，0.536；P=.012）与 LM 患者的 OS 显著相关。
在 NSCLC 患者中，EGFR 突变不是 LM 的独立危险因素。然而，LM 的存在是 EGFR 突变型 NSCLC 患者一线 EGFR-TKI 治疗的阴性预测因素。
