Epidemiology and Biostatistics, University of Auckland, New Zealand.
Pharmacology and Clinical Pharmacology, University of Auckland, New Zealand; Auckland Cancer Society Research Centre, University of Auckland, New Zealand.
Cancer Epidemiol. 2020 Dec;69:101847. doi: 10.1016/j.canep.2020.101847. Epub 2020 Oct 27.
Previous studies have reported inconsistent results regarding the effect of epidermal growth factor receptor (EGFR) mutations on overall survival in patients with non-squamous non-small-cell lung cancer (NSCLC). This study assesses the effect of EGFR mutation on overall survival, and how the effects of other survival predictors differ by EGFR mutation status.
The study used a population- based cohort of 1534 non-squamous NSCLC patients diagnosed in northern New Zealand between 1st February 2010 and 31st July 2017. Cox regression survival analyses were used to explore the associations between clinicopathological factors and overall survival by EGFR mutation status. The factors included were age at diagnosis, sex, ethnicity, smoking status, performance status, metastasis status and tumour site.
In this cohort, 20% had anEGFR mutation. The median overall survival times were 0.8 years and 2.79 years in EGFR-mutation-negative and -positive groups, respectively (p < 0.0001). Metastasis at diagnosis showed large effects on overall survival in both EGFR-mutation- negative (hazard ratio (HR) = 3.6) and mutation-positive (HR = 3.3) groups. In subgroup analyses by mutation status and metastasis, females had lower survival only if they were mutation-positive; Māori had lower survival (than European New Zealanders) only if the disease was metastatic, and tumour site had significant effects only in patients without metastasis. Age, performance status and smoking status showed consistent effects in all subgroups.
EGFR mutation status and metastasis are the main predictors for overall survival in non-squamous NSCLC patients. The effects of sex, ethnicity and tumour site vary depending on EGFR mutation and metastasis status.
先前的研究报告称，表皮生长因子受体（EGFR）突变对非鳞状非小细胞肺癌（NSCLC）患者的总生存影响不一致。本研究评估了 EGFR 突变对总生存的影响，以及其他生存预测因素的影响如何因 EGFR 突变状态而异。
该研究使用了一个基于人群的队列，包括 2010 年 2 月 1 日至 2017 年 7 月 31 日期间在新西兰北部诊断的 1534 名非鳞状 NSCLC 患者。Cox 回归生存分析用于根据 EGFR 突变状态探讨临床病理因素与总生存之间的关联。包括的因素有诊断时的年龄、性别、种族、吸烟状况、表现状态、转移状态和肿瘤部位。
在该队列中，20%的患者存在 EGFR 突变。EGFR 突变阴性和阳性组的中位总生存时间分别为 0.8 年和 2.79 年（p<0.0001）。诊断时的转移对 EGFR 突变阴性（危险比（HR）=3.6）和突变阳性（HR=3.3）组的总生存均有较大影响。根据突变状态和转移的亚组分析，只有在 EGFR 突变阳性的情况下，女性的生存才较低；毛利人（Māori）只有在疾病转移的情况下生存才较低（比欧洲裔新西兰人低），而肿瘤部位仅在无转移的患者中才有显著影响。年龄、表现状态和吸烟状况在所有亚组中均具有一致的影响。
EGFR 突变状态和转移是非鳞状 NSCLC 患者总生存的主要预测因素。性别、种族和肿瘤部位的影响因 EGFR 突变和转移状态而异。
