Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Oncology. 2021;99(1):32-40. doi: 10.1159/000509664. Epub 2020 Sep 7.
The characteristics and efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) in advanced EGFR-mutant lung adenocarcinoma patients with primary tumor resection (PTR) is not yet clear.
We enrolled advanced EGFR-mutant lung adenocarcinoma patients with EGFR-TKI as first-line therapy to access the impact of PTR on the outcomes.
A total of 466 patients were enrolled with 76 patients (16.3%) undergoing PTR; 59 patients recurred after curative surgery, while 17 patients underwent surgery as diagnostic purposes. PTR patients displayed a better performance status, a lower metastatic burden, and much less measurable diseases (30.3 vs. 97.4%, p < 0.001). PTR patients experienced a significantly longer progression-free survival (25.1 [95% CI 16.6-33.7] vs. 9.4 [95% CI 8.4-10.4] months; aHR 0.40 [95% CI 0.30-0.54], p < 0.001) and overall survival (56.8 [95% CI 36.3-77.2] vs. 31.8 [95% CI 28.2-35.4] months; aHR 0.57 [95% CI 0.39-0.84], p = 0.004). Survival advantage was still observed while comparing PTR patients with the better performance and lower metastatic burden subgroup found within the non-resection group. Moreover, the progression-free survival and overall survival of 11 patients who were found having pleural metastases during surgery and underwent PTR plus pleural biopsy, were also longer than those with pure N0--1/M1a-malignant pleural effusion disease in the non-resection group (n = 19) (p < 0.001 and p = 0.002, respectively).
PTR was associated with significantly better outcomes in advanced lung adenocarcinoma patients treated with EGFR-TKI. Further studies are needed to evaluate the biological role of PTR among these patients.
表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKI）在接受原发肿瘤切除术（PTR）的晚期 EGFR 突变型肺腺癌患者中的特征和疗效尚不清楚。
我们纳入了接受 EGFR-TKI 作为一线治疗的晚期 EGFR 突变型肺腺癌患者，以评估 PTR 对结局的影响。
共纳入 466 例患者，其中 76 例（16.3%）患者接受 PTR；59 例患者在根治性手术后复发，17 例患者因诊断目的而行手术。PTR 患者的表现状态更好，转移负担更低，可测量疾病更少（30.3%比 97.4%，p<0.001）。PTR 患者的无进展生存期（25.1[95%CI 16.6-33.7]比 9.4[95%CI 8.4-10.4]个月；aHR 0.40[95%CI 0.30-0.54]，p<0.001）和总生存期（56.8[95%CI 36.3-77.2]比 31.8[95%CI 28.2-35.4]个月；aHR 0.57[95%CI 0.39-0.84]，p=0.004）均显著延长。在非切除术组中，与表现状态更好、转移负担更低的亚组比较，PTR 患者仍存在生存优势。此外，在手术中发现胸膜转移并接受 PTR 加胸膜活检的 11 例患者的无进展生存期和总生存期也长于非切除术组中单纯 N0--1/M1a 恶性胸腔积液疾病的 19 例患者（p<0.001 和 p=0.002）。
PTR 与接受 EGFR-TKI 治疗的晚期肺腺癌患者的显著更好结局相关。需要进一步研究来评估 PTR 在这些患者中的生物学作用。
