Yotsukura Masaya, Yasuda Hiroyuki, Shigenobu Takao, Kaseda Kaoru, Masai Kyohei, Hayashi Yuichiro, Hishida Tomoyuki, Ohtsuka Takashi, Naoki Katsuhiko, Soejima Kenzo, Betsuyaku Tomoko, Asamura Hisao
Division of Thoracic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Department of Pulmonology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Lung Cancer. 2017 Jul;109:45-51. doi: 10.1016/j.lungcan.2017.04.014. Epub 2017 Apr 23.
Over the past decade, the biological and clinical characteristics of lung cancer with epidermal growth factor receptor (EGFR) mutation have been well studied. However, most studies have focused on advanced inoperable cancer, and not on resected early-stage lung adenocarcinoma. We aimed to elucidate the differences in the clinicopathological characteristics and postoperative prognosis according to the EGFR mutation status in early-stage lung adenocarcinoma.
We retrospectively collected clinical and pathological data from 369 patients with pathological stage I or II lung adenocarcinoma who underwent complete resection. Clinicopathological characteristics and postoperative prognosis were compared depending on the EGFR mutation status, using the Chi-squared test and the log-rank test, respectively.
Of the 369 patients, 160 (43.3%) had EGFR mutation, of which 64 (40.0%) were exon 19 deletion (Del-19) and 90 (56.3%) were exon 21 point mutation L858R. Although there was no difference in overall survival (OS) between patients with and without EGFR mutation (p=0.086), tumors with EGFR mutation were associated with a lower consolidation to tumor ratio (CTR) (p <0.001) and a higher incidence of a lepidic growth pattern by pathological evaluation (p <0.001) compared to those without EGFR mutation. Among tumors with EGFR mutation, there was no difference in OS (p=0.140) between Del-19 and L858R. Tumors with L858R were associated with a lower CTR (p=0.046), and tended to have a higher incidence of a lepidic growth pattern by pathological evaluation (p=0.073) compared to those with Del-19. In conclusion, although EGFR mutation status was not a prognostic indicator after surgery in early-stage lung adenocarcinoma, L858R and Del-19 had different radiological and pathological features.
在过去十年中，对具有表皮生长因子受体（EGFR）突变的肺癌的生物学和临床特征进行了深入研究。然而，大多数研究集中在晚期不可切除的癌症上，而非切除的早期肺腺癌。我们旨在阐明早期肺腺癌中EGFR突变状态与临床病理特征及术后预后的差异。
我们回顾性收集了369例接受根治性切除的病理分期为Ⅰ期或Ⅱ期肺腺癌患者的临床和病理数据。分别采用卡方检验和对数秩检验，根据EGFR突变状态比较临床病理特征和术后预后。
369例患者中，160例（43.3%）存在EGFR突变，其中64例（40.0%）为外显子19缺失（Del-19），90例（56.3%）为外显子21点突变L858R。尽管EGFR突变患者与未突变患者的总生存期（OS）无差异（p=0.086），但与未发生EGFR突变的肿瘤相比，发生EGFR突变的肿瘤实性成分与肿瘤大小比值（CTR）较低（p<0.001），且病理评估显示鳞屑样生长模式的发生率较高（p<0.001）。在发生EGFR突变的肿瘤中，Del-19与L858R的OS无差异（p=0.140）。与Del-19相比，L858R的肿瘤CTR较低（p=0.046），且病理评估显示鳞屑样生长模式的发生率有更高的趋势（p=0.073）。总之，虽然EGFR突变状态不是早期肺腺癌术后的预后指标，但L858R和Del-19具有不同的影像学和病理特征。
