在真实临床环境中，表皮生长因子受体突变型肺腺癌患者再活检的临床影响。
Clinical impact of rebiopsy among patients with epidermal growth factor receptor-mutant lung adenocarcinoma in a real-world clinical setting.
机构信息
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Chonnam National University Medical School, and Chonnam National University Hwasun Hospital, Hwasun, South Korea.
出版信息
Thorac Cancer. 2021 Mar;12(6):890-898. doi: 10.1111/1759-7714.13857. Epub 2021 Feb 2.
BACKGROUND
In this study, we investigated the risk factors of acquired T790M mutation among patients with lung adenocarcinoma with epidermal growth factor receptor (EGFR) tyrosine mutation who were treated with EGFR-tyrosine kinase inhibitors (TKIs). The aim was to identify the clinical impact of rebiopsy.
METHODS
This multicenter, retrospective cohort study was conducted in South Korea from January 2007 to June 2017. Patients with adenocarcinoma with EGFR mutation who underwent rebiopsy and were treated with EGFR-TKIs were included.
RESULTS
Of a total of 352 patients, T790M mutation was identified in 156 (41.9%) at the time of rebiopsy. The median duration from initial biopsy to rebiopsy was 17 months. Univariate logistic regression analysis revealed associations of exon 19 deletion (odds ratio [OR], 1.643; p = 0.026), absence of L858R (OR, 0.627; p = 0.042), and previous EGFR-TKI treatment duration (OR, 1.039; p < 0.001) with T790M mutation. Previous EGFR-TKI treatment duration (OR, 3.580; p < 0.001) was independently associated with T790M mutation. A multivariate Cox proportional hazard model revealed that brain metastasis at initial diagnosis (hazard ratio, 1.390; p = 0.050) tended to be associated with T790M mutation. Among the patients with T790M mutation at rebiopsy, the osimertinib user group (n = 90) had a better one-year survival (68.7 vs. 58.3%, p = 0.048) than the osimertinib nonuser group (n = 66).
CONCLUSIONS
Rebiopsy might affect the clinical course of patients with EGFR-mutant adenocarcinoma who receive EGFR-TKIs.
背景
在这项研究中，我们调查了接受表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）治疗的具有 EGFR 突变的肺腺癌患者中获得性 T790M 突变的风险因素。目的是确定再次活检的临床影响。
方法
这是一项在韩国进行的多中心、回顾性队列研究，时间为 2007 年 1 月至 2017 年 6 月。纳入接受 EGFR-TKI 治疗并再次接受活检的腺癌患者。
结果
在总共 352 名患者中，有 156 名（41.9%）在再次活检时发现 T790M 突变。初次活检至再次活检的中位时间为 17 个月。单变量逻辑回归分析显示，外显子 19 缺失（比值比 [OR]，1.643；p = 0.026）、缺乏 L858R（OR，0.627；p = 0.042）和之前的 EGFR-TKI 治疗时间（OR，1.039；p < 0.001）与 T790M 突变相关。先前的 EGFR-TKI 治疗时间（OR，3.580；p < 0.001）与 T790M 突变独立相关。多变量 Cox 比例风险模型显示，初始诊断时脑转移（风险比，1.390；p = 0.050）与 T790M 突变相关。在再次活检时存在 T790M 突变的患者中，奥希替尼使用者组（n = 90）的一年生存率（68.7%比 58.3%，p = 0.048）优于奥希替尼非使用者组（n = 66）。
结论
再次活检可能会影响接受 EGFR-TKI 治疗的具有 EGFR 突变的腺癌患者的临床过程。
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