Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Road, Jinan, Shandong, 250021, China.
J Cancer Res Clin Oncol. 2020 Jan;146(1):197-203. doi: 10.1007/s00432-019-03043-6. Epub 2019 Oct 10.
Evidence from multiple clinical trials showed that local consolidative therapy (LCT) improved survival in oligometastatic non-small cell lung cancer (NSCLC) patients. In the present study, we aim to explore the potential role of microwave ablation (MWA) as LCT for epidermal growth factor receptor (EGFR)-mutant advanced NSCLC patients with extracranial oligometastasis.
From January 2015 to December 2018, a total of 86 EGFR-mutant stage IIIB or IV NSCLC patients with extracranial oligometastasis were enrolled for retrospective analysis. MWA was used as LCT for all oligometastatic lesions and/or primary tumors in 34 patients without progression after first-line EGFR-TKIs therapy (consolidation group), while the other 52 patients received only TKIs until disease progression (monotherapy group). We calculated and compared the progression-free survival (PFS) and overall survival (OS) of the two groups.
Patients with MWA consolidation therapy had significantly improved PFS (median 16.7 vs. 12.9 months, HR 0.44, 95% CI 0.22-0.88, P = 0.02) and OS (median: 34.8 vs. 22.7 months, HR 0.45, 95% CI 0.24-0.88, P = 0.04) than monotherapy group. MWA for LCT was identified as the independent predictive factor for better PFS (HR 0.46, 95% CI 0.37-0.82, P < 0.01) and OS (HR 0.57, 95% CI 0.33-0.91, P = 0.02). Most toxicities were mild and well tolerated. No patient had to discontinue EGFR-TKIs because of MWA complications. These findings suggest that MWA as local consolidative therapy after first-line EGFR-TKIs treatment leads to better disease control and survival than TKIs monotherapy in EGFR-mutant advanced NSCLC patients with extracranial oligometastasis. MWA as a novel option of LCT might be considered for clinical management of these patients.
多项临床试验的证据表明，局部巩固治疗（LCT）可改善寡转移非小细胞肺癌（NSCLC）患者的生存。本研究旨在探讨微波消融（MWA）作为表皮生长因子受体（EGFR）突变型晚期 NSCLC 伴颅外寡转移患者 LCT 的潜在作用。
回顾性分析 2015 年 1 月至 2018 年 12 月间 86 例 EGFR 突变型 IIIB 或 IV 期 NSCLC 伴颅外寡转移患者。一线 EGFR-TKIs 治疗后无进展的 34 例患者（巩固组）接受 MWA 作为所有寡转移病灶和/或原发肿瘤的 LCT，而另外 52 例患者仅接受 TKIs 治疗至疾病进展（单药组）。我们计算并比较了两组的无进展生存期（PFS）和总生存期（OS）。
MWA 巩固治疗组患者的 PFS（中位 16.7 比 12.9 个月，HR 0.44，95%CI 0.22-0.88，P=0.02）和 OS（中位：34.8 比 22.7 个月，HR 0.45，95%CI 0.24-0.88，P=0.04）均明显改善。MWA 作为 LCT 是 PFS（HR 0.46，95%CI 0.37-0.82，P<0.01）和 OS（HR 0.57，95%CI 0.33-0.91，P=0.02）的独立预测因素。大多数毒性反应轻微且可耐受。没有患者因 MWA 并发症而停止 EGFR-TKIs 治疗。这些发现表明，一线 EGFR-TKIs 治疗后，MWA 作为局部巩固治疗可改善 EGFR 突变型晚期 NSCLC 伴颅外寡转移患者的疾病控制和生存，优于 TKIs 单药治疗。MWA 作为一种新的 LCT 选择，可考虑用于这些患者的临床管理。
