Taniguchi Yoshihiko, Tamiya Akihiro, Nakahama Kenji, Naoki Yoko, Kanazu Masaki, Omachi Naoki, Okishio Kyoichi, Kasai Takahiko, Atagi Shinji
Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan.
Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka 560-8552, Japan.
Oncol Lett. 2017 Dec;14(6):7589-7596. doi: 10.3892/ol.2017.7125. Epub 2017 Oct 3.
The aim of the present study was to analyze the impact of metastatic status on the prognosis of epithelial growth factor receptor () mutation-positive patients with non-small cell lung cancer (NSCLC) treated with first-generation EGFR-tyrosine kinase inhibitors (TKIs). A total of 178 mutation-positive patients with stage IIIB-IV and relapsed NSCLC who were treated with gefitinib or erlotinib as the first-line treatment were enrolled in the present study. Metastatic status, progression-free survival (PFS), overall survival (OS) and treatment-response rates were investigated. The association between the number of metastatic organ sites and patient prognosis was also investigated. The median age at the time of treatment was 72 (range, 39-91) years. A total of 168 patients had adenocarcinoma; 156 were treated with gefitinib. Patients with brain metastases, bone metastases, liver metastases and pleural effusion exhibited a significantly reduced PFS and OS time in the univariate analysis, compared with patients without each of these symptoms. In the multivariate analysis, bone metastasis was associated with a poorer PFS (hazard ratio, 2.11; 95% confidence interval, 1.44-3.09; P<0.001) and brain metastasis was associated with a poorer OS (hazard ratio, 2.41; 95% confidence interval, 1.46-3.95; P<0.001). No association was observed between metastatic status and treatment response rates. Higher numbers of different sites of organ metastases were associated with significantly poorer PFS and OS. Bone, brain metastasis and higher numbers of metastatic organ sites are negative prognostic factors for mutation-positive NSCLC patients treated with first-generation EGFR-TKIs.
本研究的目的是分析转移状态对接受第一代表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKIs）治疗的EGFR突变阳性非小细胞肺癌（NSCLC）患者预后的影响。本研究共纳入了178例IIIB-IV期且复发的NSCLC患者，这些患者接受吉非替尼或厄洛替尼作为一线治疗，均为EGFR突变阳性。研究了转移状态、无进展生存期（PFS）、总生存期（OS）和治疗缓解率。还研究了转移器官部位数量与患者预后之间的关联。治疗时的中位年龄为72岁（范围39-91岁）。共有168例患者患有腺癌；156例接受吉非替尼治疗。在单因素分析中，与没有脑转移、骨转移、肝转移和胸腔积液的患者相比，出现这些症状的患者PFS和OS时间显著缩短。在多因素分析中，骨转移与较差的PFS相关（风险比，2.11；95%置信区间，1.44-3.09；P<0.001），脑转移与较差的OS相关（风险比，2.41；95%置信区间，1.46-3.95；P<0.001）。未观察到转移状态与治疗缓解率之间的关联。不同器官转移部位数量越多，PFS和OS越差。骨转移、脑转移以及转移器官部位数量较多是接受第一代EGFR-TKIs治疗的EGFR突变阳性NSCLC患者的不良预后因素。
