Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
World J Surg Oncol. 2017 Nov 6;15(1):197. doi: 10.1186/s12957-017-1251-z.
The aim of this retrospective study is to identify epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer patients and to compare the long-term postoperative outcomes in different EGFR-TKI-targeted therapy effects between the different EGFR mutation groups.
A total of 2094 postoperative non-small cell lung cancer (NSCLC) patients with EGFR gene detection were collected in the Department of Pathology in the Cancer Hospital Chinese Academy of Medical Sciences from January 2003 to January 2014. Three hundred sixty-three patients were treated with EGFR tyrosine kinase inhibitor (TKI) after surgery: 184 harbored the exon 19 deletion mutation and 179 cases carried the exon 21 L858R point mutation. The end points included progression-free survival (PFS), overall survival (OS), and the response rate.
OS was increased in the EGFR exon 19 deletion group compared with the exon 21 L858R point mutation group (92 vs. 65 months; P < 0.001). But the median PFS did not differ between two groups (12 vs 14 months). The objective response rate (ORR) in 19 deletion group was increased compared with L858R mutation patients (28.35 vs. 22.73%). The disease control rate (DCR) of patients with 19 deletion benefited more from targeted therapy, compared with L858R group (93.71 vs. 84.31%, P = 0.014). In 19 deletion group, a high ORR and DCR were noted in patients treated with icotinib, 16 out of 18 achieved stable disease (SD), and the DCR in this population was 100%.
EGFR subtypes could influence the postoperative survival of NSCLC patients with TKI-targeted therapy.
本回顾性研究旨在鉴定非小细胞肺癌（NSCLC）患者表皮生长因子受体（EGFR）突变，并比较不同 EGFR 突变亚组中不同 EGFR-TKI 靶向治疗效果的长期术后结局。
收集中国医学科学院肿瘤医院病理科 2003 年 1 月至 2014 年 1 月 2094 例 EGFR 基因检测的术后 NSCLC 患者，363 例患者术后接受 EGFR 酪氨酸激酶抑制剂（TKI）治疗：184 例患者携带外显子 19 缺失突变，179 例患者携带外显子 21 L858R 点突变。终点包括无进展生存期（PFS）、总生存期（OS）和反应率。
EGFR 外显子 19 缺失组的 OS 高于外显子 21 L858R 点突变组（92 比 65 个月；P<0.001）。但两组中位 PFS 无差异（12 比 14 个月）。19 缺失组的客观缓解率（ORR）高于 L858R 突变患者（28.35%比 22.73%）。与 L858R 组相比，19 缺失组患者的疾病控制率（DCR）从靶向治疗中获益更多（93.71%比 84.31%，P=0.014）。在 19 缺失组中，接受伊可替尼治疗的患者 ORR 和 DCR 较高，18 例患者中有 16 例达到稳定疾病（SD），该人群的 DCR 为 100%。
EGFR 亚型可影响 NSCLC 患者 TKI 靶向治疗后的生存。
