新西兰毛利人和太平洋岛民人群中 EGFR 突变型非小细胞肺癌的发病率和风险增加。
Population-based incidence rates and increased risk of EGFR mutated non-small cell lung cancer in Māori and Pacifica in New Zealand.
机构信息
Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand.
出版信息
PLoS One. 2021 May 7;16(5):e0251357. doi: 10.1371/journal.pone.0251357. eCollection 2021.
BACKGROUND
Non-squamous non-small cell lung cancer (NSCLC) patients with Epidermal Growth Factor Receptor (EGFR) mutation benefit from targeted treatments. Previous studies reported EGFR mutation-positive proportions among tested non-squamous NSCLC patients. However, incidence rates and population risk of EGFR mutation-positive and EGFR mutation-negative non-squamous NSCLC have not been assessed. This study therefore aimed to estimate the population-based incidence rates of EGFR mutation-positive and EGFR mutation-negative non-squamous NSCLC in different population groups defined by sex, ethnic group and smoking status.
METHODS
This study included data from all non-squamous NSCLC patients diagnosed in northern New Zealand between 1/02/2010 and 31/07/2017 (N = 3815), obtained from a population-based cancer registry. Age-specific incidence rates, WHO age-standardised rates (ASRs) and rates adjusted for incomplete testing were calculated for EGFR mutation-positive and EGFR mutation-negative diseases for the study cohort as a whole and subgroups of patients.
RESULTS
Among 3815 patients, 45% were tested for EGFR mutations; 22.5% of those tested were EGFR mutation-positive. The ASR of EGFR mutation-positive NSCLC was 5.05 (95%CI 4.71-5.39) per 100,000 person-years. ASRs for EGFR mutation-positive NSCLC were higher for females than males: standardised incidence ratio (SIR) 1.50 (1.31-1.73); higher for Pacifica, Asians and Māori compared with New Zealand Europeans: SIRs 3.47 (2.48-4.85), 3.35 (2.62-4.28), and 2.02 (1.43-2.87), respectively; and, only slightly increased in ever-smokers compared with never-smokers: SIR 1.25 (1.02-1.53). In contrast, the ASR of EGFR mutation-negative NSCLC was 17.39 (16.75-18.02) per 100,000 person-years, showing a strong association with smoking; was higher for men; highest for Māori, followed by Pacifica and then New Zealand Europeans, and lowest for Asians. When corrected for incomplete testing, SIRs by sex, ethnicity and smoking, for both diseases, remained similar to those based on tested patients.
CONCLUSION
The population risk of EGFR mutation-positive NSCLC was significantly higher for Māori and Pacifica compared with New Zealand Europeans.
背景
表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者受益于靶向治疗。先前的研究报告了经检测的非鳞状 NSCLC 患者中 EGFR 突变阳性的比例。然而，EGFR 突变阳性和 EGFR 突变阴性非鳞状 NSCLC 的发病率和人群风险尚未评估。因此，本研究旨在估计按性别、种族和吸烟状况定义的不同人群中 EGFR 突变阳性和 EGFR 突变阴性非鳞状 NSCLC 的基于人群的发病率。
方法
本研究纳入了 2010 年 2 月 1 日至 2017 年 7 月 31 日期间在新西兰北部诊断的所有非鳞状 NSCLC 患者（N=3815）的数据，这些数据来自一个基于人群的癌症登记处。为整个研究队列和患者亚组计算了 EGFR 突变阳性和 EGFR 突变阴性疾病的年龄特异性发病率、世界卫生组织年龄标准化率（ASR）和经不完全检测校正的率。
结果
在 3815 名患者中，有 45%接受了 EGFR 突变检测；在接受检测的患者中，有 22.5%为 EGFR 突变阳性。EGFR 突变阳性 NSCLC 的 ASR 为每 100,000 人年 5.05（95%CI 4.71-5.39）。女性 EGFR 突变阳性 NSCLC 的 ASR 高于男性：标准化发病率比（SIR）为 1.50（1.31-1.73）；与新西兰欧洲人相比，太平洋岛民、亚洲人和毛利人更高：SIR 分别为 3.47（2.48-4.85）、3.35（2.62-4.28）和 2.02（1.43-2.87）；与从不吸烟者相比，仅略有增加：SIR 为 1.25（1.02-1.53）。相比之下，EGFR 突变阴性 NSCLC 的 ASR 为每 100,000 人年 17.39（16.75-18.02），与吸烟密切相关；男性较高；毛利人最高，其次是太平洋岛民，然后是新西兰欧洲人，亚洲人最低。当根据不完全检测进行校正时，两种疾病的性别、种族和吸烟因素的 SIR 与基于检测患者的 SIR 相似。
结论
与新西兰欧洲人相比，毛利人和太平洋岛民的 EGFR 突变阳性 NSCLC 的人群风险明显更高。
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