Isaka Tetsuya, Ito Hiroyuki, Nakayama Haruhiko, Yokose Tomoyuki, Yamada Kouzo, Masuda Munetaka
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.
Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan.
Lung Cancer. 2020 Jul;145:111-118. doi: 10.1016/j.lungcan.2020.04.012. Epub 2020 May 11.
This study evaluated the effect of EGFR mutation on early-stage non-small cell lung cancer (NSCLC) based on the 8th TNM classification.
The study retrospectively examined 1231 patients who underwent curative resection for pathological stage 0-I (8th TNM classification) NSCLC and EGFR mutation analysis from January 2006 to December 2018 at Kanagawa Cancer Center. The disease-free survival (DFS), overall survival (OS) and disease-specific survival (DSS) of EGFR-mutant lung cancer (Mt) and EGFR wild-type lung cancer (Wt) patients at each stage were compared between two patient groups using the log-rank test. Cox regression analyses were performed to identify prognostic factors.
The number of stage 0, IA1, IA2, IA3, and IB Mt/Wt patients was 79/92, 202/189, 145/144, 45/75, and 74/186, respectively. There was no statistically significant difference in DFS between Mt and Wt patients at any pathological stage. The 5-year OS of Mt/Wt patients was 96.9 %/98.5 % for stage 0 (p = 0.671), 92.2 %/92.2 % for stage IA1 (p = 0.997), 93.9 %/82.6 % for stage IA2 (p = 0.039), 87.3 %/91.4 % for stage IA3 (p = 0.768), and 85.3 %/69.3 % for stage IB (p = 0.017). The 5-year DSS of Mt/Wt patients was 95.7 %/95.4 % for stage IA2 (p = 0.684) and 93.2 %/77.5 % for stage IB (p = 0.016). In Cox regression analyses, Mt was not identified as a prognostic factor for OS among stage IA2 NSCLC patients (HR, 0.62; 95 % CI, 0.20-1.93; p = 0.413). However, Mt was a favorable prognostic factor for OS (HR, 0.44; 95 % CI, 0.19-1.00; p = 0.049) and DSS (HR, 0.38; 95 % CI, 0.17-0.87; p = 0.022) among stage IB NSCLC patients.
EGFR mutation had no effect on the prognosis of stage 0-IA NSCLC but significantly affected the OS and DSS of stage IB NSCLC. Effect of EGFR mutations on postoperative prognosis of patients with stage 0-I NSCLC differed with each stage.
本研究基于第8版TNM分类评估表皮生长因子受体（EGFR）突变对早期非小细胞肺癌（NSCLC）的影响。
本研究回顾性分析了2006年1月至2018年12月在神奈川县癌症中心接受0-I期（第8版TNM分类）NSCLC根治性切除及EGFR突变分析的1231例患者。采用对数秩检验比较两个患者组中各阶段EGFR突变型肺癌（Mt）和EGFR野生型肺癌（Wt）患者的无病生存期（DFS）、总生存期（OS）和疾病特异性生存期（DSS）。进行Cox回归分析以确定预后因素。
0期、IA1期、IA2期、IA3期和IB期的Mt/Wt患者数量分别为79/92、202/189、145/144、45/75和74/186。在任何病理阶段，Mt和Wt患者的DFS均无统计学显著差异。0期Mt/Wt患者的5年OS分别为96.9%/98.5%（p = 0.671），IA1期为92.2%/92.2%（p = 0.997），IA2期为93.9%/82.6%（p = 0.039），IA3期为87.3%/91.4%（p = 0.768），IB期为85.3%/69.3%（p = 0.017）。IA2期Mt/Wt患者的5年DSS分别为95.7%/95.4%（p = 0.684），IB期为93.2%/77.5%（p = 0.016）。在Cox回归分析中，Mt未被确定为IA2期NSCLC患者OS的预后因素（风险比[HR]，0.62；95%置信区间[CI]，0.20 - 1.93；p = 0.413）。然而，Mt是IB期NSCLC患者OS（HR，0.44；95% CI，0.19 - 1.00；p = 0.049）和DSS（HR，0.38；95% CI，0.17 - 0.87；p = 0.022）的有利预后因素。
EGFR突变对0-IA期NSCLC的预后无影响，但对IB期NSCLC的OS和DSS有显著影响。EGFR突变对0-I期NSCLC患者术后预后的影响因阶段而异。
