表皮生长因子受体基因突变对第 8 版 TNM 分期病理Ⅱ-ⅢA 期（可切除）原发性肺癌术后预后的影响。

Effect of epidermal growth factor receptor gene mutation on the prognosis of pathological stage II-IIIA (8th edition TNM classification) primary lung cancer after curative surgery.

机构信息

Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan; Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.

Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan.

出版信息

Lung Cancer. 2021 Dec;162:128-134. doi: 10.1016/j.lungcan.2021.11.002. Epub 2021 Nov 8.

DOI:10.1016/j.lungcan.2021.11.002

PMID:34775216

Abstract

OBJECTIVES

This retrospective study aimed to elucidate the effect of epidermal growth factor receptor (EGFR) gene mutations on the prognosis of patients with pathological stage II-IIIA primary lung cancer after curative surgery.

MATERIALS AND METHODS

We enrolled 539 patients with p-stage II-IIIA (8th edition tumor-node-metastasis [TNM] classification) lung cancer who underwent curative resection at Kanagawa Cancer Center between January 2010 and December 2020 and whose tumors were tested for EGFR mutations. Relapse-free survival (RFS) and overall survival (OS) of patients with EGFR-mutant lung cancer (Mt, n = 126) including EGFR exon 21 L858R point mutation and EGFR exon 19 deletion mutation and EGFR mutation-wild lung cancer (Wt, n = 413) were analyzed using Kaplan-Meier curves and compared using a log-rank test. Cox regression analysis was performed to evaluate the effects of EGFR gene mutations on RFS and OS at each stage.

RESULTS

There were 56/256 patients with p-stage II EGFR-Mt/Wt and 70/157 patients with p-stage IIIA EGFR-Mt/Wt. The 5-year RFS rate of patients with EGFR-Mt/Wt was 46.6%/52.0% (p = 0.787) for p-stage II and 17.4%/29.7% (p = 0.929) for p-stage IIIA. The 5-year OS rate was 92.0%/65.7% (p = 0.001) for p-stage II and 56.0%/39.3% (p = 0.016) for p-stage IIIA. EGFR-Mt was not an independent prognostic factor for OS of patients with p-stage IIIA lung cancer (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.51-1.76; p = 0.872); however, EGFR-Mt was an independent favorable prognostic factor for OS of patients with p-stage II lung cancer (HR, 0.59; 95% CI, 0.36-0.96; p = 0.034).

CONCLUSION

The OS of lung cancer patients with p-stage II or IIIA, classified according to the 8th edition TNM classification, was remarkably favorable. Incorporating EGFR mutations to the anatomical TNM classification may lead to a more accurate prognosis prediction.

摘要

目的

本回顾性研究旨在阐明表皮生长因子受体（EGFR）基因突变对接受根治性手术的病理性 II 期-IIIA 期原发性肺癌患者预后的影响。

材料与方法

我们纳入了 539 名在 2010 年 1 月至 2020 年 12 月期间于神奈川癌症中心接受根治性切除术且肿瘤检测 EGFR 基因突变的 p 期 II-IIIA 期（第 8 版肿瘤-淋巴结-转移 [TNM] 分类）肺癌患者。分析包括 EGFR 外显子 21 L858R 点突变和 EGFR 外显子 19 缺失突变在内的 EGFR 突变型肺癌（Mt，n=126）和 EGFR 野生型肺癌（Wt，n=413）患者的无复发生存期（RFS）和总生存期（OS），采用 Kaplan-Meier 曲线进行分析，并采用对数秩检验进行比较。采用 Cox 回归分析评估 EGFR 基因突变对各期 RFS 和 OS 的影响。

结果

p 期 II 期有 56/256 例患者为 EGFR-Mt/Wt，p 期 IIIA 期有 70/157 例患者为 EGFR-Mt/Wt。EGFR-Mt/Wt 患者的 5 年 RFS 率在 p 期 II 期为 46.6%/52.0%（p=0.787），在 p 期 IIIA 期为 17.4%/29.7%（p=0.929）。5 年 OS 率在 p 期 II 期为 92.0%/65.7%（p=0.001），在 p 期 IIIA 期为 56.0%/39.3%（p=0.016）。EGFR-Mt 不是 p 期 IIIA 期肺癌患者 OS 的独立预后因素（风险比 [HR]，0.95；95%置信区间 [CI]，0.51-1.76；p=0.872）；然而，EGFR-Mt 是 p 期 II 期肺癌患者 OS 的独立有利预后因素（HR，0.59；95%CI，0.36-0.96；p=0.034）。