Ding Pei N, Roberts Tara L, Chua Wei, Becker Therese M, Descallar Joseph, Yip Po Y, Bray Victoria
Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.
Medical Oncology Department, Liverpool Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2017 Dec;47(12):1405-1411. doi: 10.1111/imj.13555.
Epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) is a subgroup of oncogene addicted lung cancer that predicts response to tyrosine kinase inhibitors (TKI). However, there is variability in response and survival outcomes in patients with EGFR mutation treated with TKI.
To describe clinical characteristics, treatment patterns and factors influencing outcomes in patients with EGFR-mutated NSCLC in South Western Sydney Local Health District.
Retrospective review of patients with EGFR-mutated NSCLC diagnosed between January 2010 and June 2016.
A total of 85 EGFR-mutated NSCLC patients was identified; 80 (94%) received first-line treatment with EGFR-TKI. The median follow-up was 10.7 months with a median duration of treatment of 9 months. On disease progression (n = 44), 37% had best supportive care only, 30% received chemotherapy, 23% participated in clinical trials, 7% continued on a first generation EGFR-TKI and 3% received afatinib. Overall response rate to first-line EGFR-TKI was 66%. Median progression-free survival (PFS) was 10.7 months (range 2.7-55.9 months) and median overall survival (OS) was 23 months (range 0.4-35.8 months). Multivariate Cox regression analysis showed that patients with lower disease burden (<4 sites) had longer PFS (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.18-0.72, P = 0.004) but not OS. Good performance status predicts longer OS (HR 0.33, CI 0.14-0.77, P = 0.01). Lower (<5) pre-treatment neutrophil-to-lymphocyte ratio (NLR) was associated with better PFS (HR 0.40, 95% CI 0.18-0.87, P = 0.02) and OS (HR 0.43, 95% CI 0.19-0.94, P = 0.04). There were no survival differences when patients were stratified by age, baseline albumin level and types of EGFR mutation.
Results from this community-based cohort confirm known prognostic factors in patients with EGFR-mutated NSCLC receiving TKI and suggest the negative influence of a heightened host systemic inflammatory response on patient outcomes.
表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）是一类对致癌基因成瘾的肺癌亚组，可预测对酪氨酸激酶抑制剂（TKI）的反应。然而，接受TKI治疗的EGFR突变患者的反应和生存结果存在差异。
描述悉尼西南部地方卫生区EGFR突变的NSCLC患者的临床特征、治疗模式及影响预后的因素。
回顾性分析2010年1月至2016年6月期间诊断为EGFR突变的NSCLC患者。
共纳入85例EGFR突变的NSCLC患者；80例（94%）接受了EGFR-TKI一线治疗。中位随访时间为10.7个月，中位治疗持续时间为9个月。疾病进展时（n = 44），37%仅接受最佳支持治疗，30%接受化疗，23%参与临床试验，7%继续使用第一代EGFR-TKI，3%接受阿法替尼治疗。一线EGFR-TKI的总体缓解率为66%。中位无进展生存期（PFS）为10.7个月（范围2.7 - 55.9个月），中位总生存期（OS）为23个月（范围0.4 - 35.8个月）。多因素Cox回归分析显示，疾病负担较低（<4个部位）的患者PFS更长（风险比（HR）0.36，95%置信区间（CI）0.18 - 0.72；P = 0.004），但OS无差异。良好的体能状态预示着更长的OS（HR 0.33，CI 0.14 - 0.77；P = 0.01）。治疗前中性粒细胞与淋巴细胞比值较低（<5）与更好的PFS（HR 0.40，95% CI 0.18 - 0.87；P = 0.02）和OS（HR 0.43，95% CI 0.19 - 0.94；P = 0.04）相关。按年龄、基线白蛋白水平和EGFR突变类型分层时，患者的生存无差异。
该社区队列研究结果证实了接受TKI治疗的EGFR突变NSCLC患者已知的预后因素，并提示宿主全身炎症反应增强对患者预后有负面影响。
