Lv Weize, Cheng Hua, Shao Di, Wei Yajun, Zhu Weiping, Wu Kui, Jiang Wenxi, Hu Liyang, Sha Zhou, Zhong Beilong, Pei Xiaofeng
Department of Interventional Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Guangdong Provincial Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Front Oncol. 2021 Mar 10;11:630717. doi: 10.3389/fonc.2021.630717. eCollection 2021.
Although the National Comprehensive Cancer Network and the Chinese Society of Clinical Oncology guidelines recommend comprehensive genomic profiling of lung adenocarcinoma, it has not been widely applied in Chinese hospitals. This observational study aimed to determine real-world evidence of whether comprehensive genomic profiling can benefit the survival of patients with lung cancer. We investigated the frequency of genomic alterations, treatment strategies, and clinical outcomes in 233 patients with advanced non-small cell lung carcinoma who were routinely screened using a 508-gene panel. The most prevalent drivers were mutations of EGFR (51%), KRAS (9%), PIK3CA (7%), ALK (7%), MET (6%), and BRAF (5%). Mutations in tumor suppressor genes included TP53, KEAP1, RB1, PTEN, and APC. Median overall survival (OS) was significantly shorter among patients harboring KRAS (mutant, n = 17; WT, n = 154) and TP53 (mutant, n = 103; WT n =68) mutations (11.3 24.0 months; P = 0.16 and 18.7 28.7 months; P = 0.018, respectively). The OS was longer among patients with tumors harboring EGFR (P = 0.069) and ALK (P = 0.51) mutations. Most patients (65.4%) with the driver gene-positive (EGFR, ALK, and ROS1) tumors were received TKI treatment, whereas those with driver gene wild tumors (53.1%) chose platinum-based therapy. Univariate and multivariate analyses associated a shorter OS among patients with tumors harboring concomitant TP53 and EGFR mutations. These findings provide additional evidence from real-world on the potential importance of targeted therapies as a treatment option in NSCLC patients harboring clinically actionable mutation.
尽管美国国立综合癌症网络和中国临床肿瘤学会指南推荐对肺腺癌进行全面基因组分析，但该方法在中国医院尚未得到广泛应用。这项观察性研究旨在确定全面基因组分析能否使肺癌患者生存获益的真实世界证据。我们调查了233例晚期非小细胞肺癌患者的基因组改变频率、治疗策略和临床结局，这些患者使用包含508个基因的检测板进行常规筛查。最常见的驱动基因是EGFR（51%）、KRAS（9%）、PIK3CA（7%）、ALK（7%）、MET（6%）和BRAF（5%）的突变。肿瘤抑制基因的突变包括TP53、KEAP1、RB1、PTEN和APC。在携带KRAS（突变型，n = 17；野生型，n = 154）和TP53（突变型，n = 103；野生型n = 68）突变的患者中，中位总生存期（OS）显著缩短（分别为11.3 24.0个月；P = 0.16和18.7 28.7个月；P = 0.018）。携带EGFR（P = 0.069）和ALK（P = 0.51）突变的肿瘤患者的OS较长。大多数驱动基因阳性（EGFR、ALK和ROS1）肿瘤患者（65.4%）接受了TKI治疗，而驱动基因野生型肿瘤患者（53.1%）选择了铂类治疗。单因素和多因素分析表明，携带TP53和EGFR共同突变的肿瘤患者的OS较短。这些发现提供了来自真实世界的额外证据，证明靶向治疗作为具有临床可操作突变的非小细胞肺癌患者的治疗选择具有潜在重要性。
