Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Ann Thorac Surg. 2021 Jan;111(1):269-276. doi: 10.1016/j.athoracsur.2020.05.041. Epub 2020 Jun 29.
To elucidate the clinical, pathologic, and prognostic impacts of epidermal growth factor receptor (EGFR) mutation and mutation subtypes in early-stage lung cancer, the study investigators conducted a retrospective analysis of the Japanese Joint Committee of Lung Cancer Registry database (a nationwide database for patients with surgically resected lung cancer; n = 18,973).
Of 13,951 patients classified as having nonsquamous non-small cell lung cancer in the database, 5780 patients (41.0%) had been tested for an EGFR mutation and were included in this study.
An EGFR mutation was detected in 2410 patients (41.7%), and the presence of an EGFR mutation was significantly correlated with clinicopathologic factors such as the presence of ground-glass opacity (P < .001) and better prognosis. Analysis of initial recurrence sites identified significantly higher frequencies of brain and adrenal gland metastases in patients with and without an EGFR mutation, respectively. Of 2410 patients with EGFR mutations, 983 (40.8%) had an exon 19 deletion (Exon 19 Del), 1170 (48.5%) had an L858R mutation, and 257 (10.7%) had other EGFR mutations. A higher smoking rate was found in patients with other EGFR mutations (P = .02). In the comparison of Exon 19 Del and L858R, we found that Exon 19 Del correlated with younger age (P < .001), a higher rate of pure solid tumors (P < .001), advanced pathologic stage (trend P < .001), and poorer recurrence-free survival (P = .001).
In addition to the clinicopathologic and prognostic impacts of EGFR mutation status, tumors with Exon 19 Del have a more aggressive phenotype and patients have a poorer prognosis than with L858R in early-stage lung cancers.
为了阐明表皮生长因子受体（EGFR）突变及其突变亚型在早期肺癌中的临床、病理和预后影响，研究人员对日本肺癌登记数据库（一个针对接受手术切除肺癌患者的全国性数据库；n=18973）进行了回顾性分析。
在数据库中，13951 例非鳞状非小细胞肺癌患者中，5780 例（41.0%）接受了 EGFR 突变检测，并纳入本研究。
2410 例（41.7%）患者检测到 EGFR 突变，EGFR 突变的存在与磨玻璃影（P<.001）等临床病理因素显著相关，且预后较好。对初始复发部位的分析发现，有和无 EGFR 突变的患者分别有更高频率的脑和肾上腺转移。在 2410 例 EGFR 突变患者中，983 例（40.8%）存在外显子 19 缺失（Exon 19 Del），1170 例（48.5%）存在 L858R 突变，257 例（10.7%）存在其他 EGFR 突变。其他 EGFR 突变患者的吸烟率较高（P=0.02）。在 Exon 19 Del 和 L858R 的比较中，我们发现 Exon 19 Del 与更年轻的年龄相关（P<.001），更高的纯实性肿瘤比例（P<.001），更晚期的病理分期（趋势 P<.001），以及更差的无复发生存率（P=0.001）。
除了 EGFR 突变状态的临床病理和预后影响外，Exon 19 Del 肿瘤具有更具侵袭性的表型，与 L858R 相比，早期肺癌患者的预后更差。
