Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Thoracic Surgery, Kitasato University Medical Center, Saitama, Japan.
Thorac Cancer. 2023 Mar;14(8):766-772. doi: 10.1111/1759-7714.14805. Epub 2023 Jan 31.
The effectiveness of local therapy has been reported in patients with oligo-recurrence of non-small cell lung cancer (NSCLC), a metachronous recurrence with a limited number of recurrences, which can be treated with local therapy. Conversely, remarkable progress has been made in systemic therapy for NSCLC with the advent of molecular targeted therapy. In particular, epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are very effective in the treatment of EGFR-mutated NSCLC. There is currently no consensus on treatment for oligo-recurrence of EGFR-mutated NSCLC.
From 2004 to 2014, 811 patients underwent complete resection for NSCLC at Kitasato University Hospital and, of these, 244 patients developed recurrence. Oligo-recurrence was defined as the presence of two or less recurrent lesions, and 34 patients presented with EGFR-mutated oligo-recurrence.
We retrospectively examined and compared the effects of EGFR-TKIs with those of radical local therapy in patients with oligo-recurrent EGFR-mutated NSCLC. The five-year post-recurrence survival (PRS) rates of patients with EGFR-mutated oligo-recurrence who received radical local therapy (n = 23) and those who did not (n = 11) were 59.4 and 45.5%, respectively (p = 0.777). Multivariate analysis revealed no favorable prognostic factors associated with prolonged PRS, and radical local therapies did not improve PRS in patients with oligo-recurrence (p = 0.551).
Radical local therapy did not affect PRS in patients with oligo-recurrent EGFR-mutated NSCLC. Even in cases of oligo-recurrence, the administration of local therapy in patients with EGFR-mutated NSCLC might be carefully considered.
局部治疗已被报道对寡复发非小细胞肺癌（NSCLC）患者有效，寡复发是指同时存在数量有限的复发灶且可以通过局部治疗控制的异时性复发。相反，随着分子靶向治疗的出现，NSCLC 的系统治疗取得了显著进展。特别是表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKI）在治疗 EGFR 突变型 NSCLC 方面非常有效。目前，对于 EGFR 突变型 NSCLC 的寡复发治疗尚无共识。
2004 年至 2014 年，Kitasato 大学医院共有 811 例 NSCLC 患者接受了完全切除术，其中 244 例患者出现复发。寡复发定义为存在两个或更少的复发病灶，34 例患者为 EGFR 突变型寡复发。
我们回顾性地检查和比较了 EGFR-TKI 与根治性局部治疗对 EGFR 突变型 NSCLC 寡复发患者的疗效。接受根治性局部治疗（n=23）和未接受根治性局部治疗（n=11）的 EGFR 突变型寡复发患者的 5 年复发后生存（PRS）率分别为 59.4%和 45.5%（p=0.777）。多因素分析显示，PR 无预后相关的有利因素，根治性局部治疗不能改善寡复发患者的 PRS（p=0.551）。
根治性局部治疗不能影响 EGFR 突变型 NSCLC 寡复发患者的 PRS。即使是寡复发，EGFR 突变型 NSCLC 患者局部治疗的应用也需要谨慎考虑。
