Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City 100, Taiwan.
Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan.
Ann Surg Oncol. 2022 Aug;29(8):4873-4884. doi: 10.1245/s10434-022-11483-7. Epub 2022 Mar 7.
In studies of stage IV epidermal growth factor receptor (EGFR)-mutant nonsmall-cell lung cancer (NSCLC), <10% of patients underwent surgery; thus, the effect of surgery in these patients remains unclear. We investigated whether primary lung tumor resection could improve the survival of patients with stage IV EGFR-mutant NSCLC without progression after first-line EGFR-tyrosine kinase inhibitor (EGFR-TKI) treatment.
This retrospective case-control study included patients treated with first-line EGFR-TKIs without progression on follow-up imaging. Patients in the surgery group (n = 56) underwent primary tumor resection, followed by TKI maintenance therapy. Patients in the control group (n = 224; matched for age, metastatic status, and Eastern Cooperative Oncology Group performance status) received only TKI maintenance therapy. Local ablative therapy for distant metastasis was allowed in both groups. The primary endpoint was progression-free survival. The secondary endpoints were overall survival, failure patterns, and complications/adverse events.
The median time from TKI treatment to surgery was 5.1 months. For the surgery and control groups, the median follow-up periods were 34.0 and 38.5 months, respectively, with a median (95% confidence interval) progression-free survival of 29.6 (18.9-40.3) and 13.0 (11.8-14.2) months, respectively (P < 0.001). Progression occurred in 29/56 (51.8%) and 207/224 (92.4%) patients, respectively. The median overall survival in the surgery group was not reached. The rate of surgical complications of grade ≥2 was 12.5%; complications were treated conservatively.
Primary tumor resection is feasible for patients with EGFR-mutant nonprogressed NSCLC during first-line EGFR-TKI treatment and may improve survival better than maintenance EGFR-TKI therapy alone.
在 IV 期表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）的研究中，<10%的患者接受了手术；因此，手术在这些患者中的效果尚不清楚。我们研究了在一线 EGFR 酪氨酸激酶抑制剂（EGFR-TKI）治疗后无进展的 IV 期 EGFR 突变型 NSCLC 患者，是否可以通过原发肿瘤切除来改善其生存。
本回顾性病例对照研究纳入了接受一线 EGFR-TKI 治疗且在随访影像学检查中无进展的患者。手术组（n=56）患者接受了原发肿瘤切除术，然后进行 TKI 维持治疗。对照组（n=224；年龄、转移状态和东部肿瘤协作组表现状态相匹配）患者仅接受 TKI 维持治疗。两组均允许对远处转移灶进行局部消融治疗。主要终点是无进展生存期。次要终点是总生存期、失败模式和并发症/不良事件。
从 TKI 治疗到手术的中位时间为 5.1 个月。手术组和对照组的中位随访时间分别为 34.0 个月和 38.5 个月，中位（95%置信区间）无进展生存期分别为 29.6（18.9-40.3）个月和 13.0（11.8-14.2）个月（P<0.001）。29/56（51.8%）和 207/224（92.4%）患者分别出现进展。手术组中位总生存期未达到。≥2 级手术并发症发生率为 12.5%；并发症采用保守治疗。
在一线 EGFR-TKI 治疗期间，对于 EGFR 突变型无进展 NSCLC 患者，行原发肿瘤切除术是可行的，与单独使用 EGFR-TKI 维持治疗相比，可能会改善生存。
