Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan.
Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan.
BMC Cancer. 2018 Oct 5;18(1):959. doi: 10.1186/s12885-018-4849-9.
The prognosis of patients with epidermal growth factor receptor (EGFR) mutant adenocarcinoma of the lung (Mt) and EGFR wild-type adenocarcinoma (Wt) after complete resection of the lung differ; however, the mechanisms responsible for these differences remain unclear. The present study examined the post-operative prognosis of recurrent pulmonary adenocarcinoma patients to evaluate the clinicopathological nature of Mt and contribution of EGFR - tyrosine kinase inhibitors (TKI) to the prognosis of patients.
The subjects were 237 patients with recurrent pulmonary adenocarcinoma who underwent EGFR mutation analysis, and consisted of 108 patients with recurrent Mt and 129 with recurrent Wt. Multivariate analyses were performed to investigate whether the EGFR status is a prognostic factor for relapse-free survival (RFS) and post-relapse survival (PRS).
RFS was significantly better in Mt than in Wt patients; median RFS were 20.2 and 13.3 months, respectively (p < 0.001). The multivariate analysis identified EGFR mutation as an independent prognostic factor for a favorable RFS (hazard ratio = 0.68; 95% confidence interval, 0.52-0.89). Although, no significant differences were observed in PRS between Mt and Wt patients (median PRS were 33.9 and 28.2 months, respectively; p = 0.360), PRS was significantly better in Mt with EGFR - TKI than in Wt and Mt patients without EGFR - TKI (p = 0.008 and p < 0.001, respectively). PRS was also significantly better in Wt than in Mt patients without EGFR - TKI (p < 0.001). The multivariate analysis identified the administration of EGFR - TKI as an independent prognostic factor for PRS (hazard ratio = 0.60; 95% confidence interval, 0.40-0.89).
EGFR mutation tumors were associated with a significantly better RFS for recurrent pulmonary adenocarcinoma after curative resection of the lung, which represented the less aggressive nature of Mt tumors. However, patients with Mt did not have a favorable prognosis after recurrence unless they received EGFR - TKI.
表皮生长因子受体（EGFR）突变型肺腺癌（Mt）和 EGFR 野生型肺腺癌（Wt）患者完全切除肺部后的预后不同，但导致这些差异的机制尚不清楚。本研究通过对复发性肺腺癌患者进行术后预后评估，来检测 Mt 的临床病理性质以及 EGFR-酪氨酸激酶抑制剂（TKI）对患者预后的贡献。
本研究纳入了 237 例复发性肺腺癌患者，这些患者均进行了 EGFR 突变分析，其中包括 108 例复发性 Mt 患者和 129 例复发性 Wt 患者。采用多变量分析来探讨 EGFR 状态是否为无复发生存期（RFS）和复发后生存期（PRS）的预后因素。
Mt 患者的 RFS 明显优于 Wt 患者；中位 RFS 分别为 20.2 个月和 13.3 个月（p<0.001）。多变量分析确定 EGFR 突变是 RFS 良好的独立预后因素（风险比=0.68；95%置信区间，0.52-0.89）。尽管 Mt 患者与 Wt 患者的 PRS 之间无显著差异（中位 PRS 分别为 33.9 个月和 28.2 个月，p=0.360），但 Mt 患者接受 EGFR-TKI 治疗后的 PRS 明显优于 Wt 患者和未接受 EGFR-TKI 治疗的 Mt 患者（p=0.008 和 p<0.001）。Wt 患者的 PRS 也明显优于未接受 EGFR-TKI 治疗的 Mt 患者（p<0.001）。多变量分析确定 EGFR-TKI 的应用是 PRS 的独立预后因素（风险比=0.60；95%置信区间，0.40-0.89）。
在肺部根治性切除术后，EGFR 突变肿瘤与复发性肺腺癌患者的 RFS 显著改善，这表明 Mt 肿瘤的侵袭性较低。然而，除非患者接受 EGFR-TKI，否则 Mt 患者复发后预后不佳。
