Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.
Thorac Cancer. 2018 Nov;9(11):1398-1405. doi: 10.1111/1759-7714.12847. Epub 2018 Aug 27.
The standard of care for fit locally advanced non-small cell lung cancer (NSCLC) patients is concurrent chemoradiotherapy (CCRT). However, in a subset of patients with lung adenocarcinoma with mutant EGFR (LA-mEGFR), the role of EGFR-tyrosine kinase inhibitors (TKIs) is not clear. We compared CCRT versus TKIs for the treatment of stage IIIb LA-mEGFR in a Taiwanese population.
We identified patients from the Taiwan Cancer Registry with good performance status at clinical stage IIIb LA-mEGFR, diagnosed from June 2011 to December 2015 and treated with either TKIs or CCRT. Clinical covariables and survival status were also collected. The Cox regression method was used in the primary analyses and several propensity score methods and alternative study cohort definitions were used in additional analyses.
We compared the data of 177 TKI and 22 CCRT patients and found no statistically significant difference in overall (adjusted hazard ratio of death 0.71, 95% confidence interval 0.34-1.47) or lung cancer-specific survival (hazard ratio 0.65, 95% confidence interval 0.31-1.35). The results of most additional analyses were insignificant.
In this population-based study from Taiwan with limited case numbers, no statistical difference in the survival outcomes of patients with clinical stage IIIb LA-mEGFR treated with either EGFR-TKIs or CCRT was determined. Further prospective studies are needed to clarify our findings.
适合局部晚期非小细胞肺癌（NSCLC）患者的标准治疗方法是同步放化疗（CCRT）。然而，在具有突变型 EGFR（LA-mEGFR）的肺腺癌患者亚组中，EGFR 酪氨酸激酶抑制剂（TKI）的作用尚不清楚。我们比较了 TKI 与 CCRT 治疗台湾人群中 IIIb 期 LA-mEGFR 的疗效。
我们从台湾癌症登记处确定了临床 IIIb 期 LA-mEGFR 患者中具有良好表现状态的患者，这些患者于 2011 年 6 月至 2015 年 12 月被诊断为 LA-mEGFR，并接受 TKI 或 CCRT 治疗。还收集了临床协变量和生存状况。在主要分析中使用了 Cox 回归方法，并在其他分析中使用了几种倾向评分方法和替代研究队列定义。
我们比较了 177 例 TKI 和 22 例 CCRT 患者的数据，在总生存期（调整死亡风险比为 0.71，95%置信区间为 0.34-1.47）或肺癌特异性生存期（风险比为 0.65，95%置信区间为 0.31-1.35）方面无统计学差异。大多数额外分析的结果无统计学意义。
在这项来自台湾的基于人群的研究中，患者数量有限，我们没有确定接受 EGFR-TKI 或 CCRT 治疗的临床 IIIb 期 LA-mEGFR 患者的生存结果存在统计学差异。需要进一步的前瞻性研究来阐明我们的发现。
