Lu Chao-Wen, Lin Mong-Wei, Chiang Xu-Heng, Hsu Hsao-Hsun, Hsieh Min-Shu, Chen Jin-Shing
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan.
Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei 100, Taiwan.
Diagnostics (Basel). 2023 Jan 20;13(3):390. doi: 10.3390/diagnostics13030390.
The clinicopathological presentation of early-stage lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutations has been seldom studied. Our study enrolled patients with stage I and II lung adenocarcinoma between January 2014 and December 2017 at the National Taiwan University Hospital. Clinicopathological features and prognosis were retrospectively reviewed and analyzed depending on EGFR mutation status. EGFR mutations were detected in 622 (60%) out of 1034 patients. Compared to the group without EGFR mutations, the group with EGFR mutations had more patients above 65 years of age ( < 0.001), more non-lepidic histological subtypes ( < 0.001), higher CEA levels ( = 0.044), higher grade of pleural ( = 0.02) and lymphovascular ( = 0.001) invasion, higher histological grade ( < 0.001), and a more advanced pathological stage ( = 0.022). In multivariate analysis, there was no significant difference in PFS or OS between the EGFR mutant and wild-type groups. In subtype analysis, the tumors with an L858R mutation had a more lepidic predominant histological type ( = 0.019) and less lymphovascular invasion ( = 0.011). No significant differences in PFS or OS were detected between the exon 19 deletion and L858R mutation groups. In early-stage lung adenocarcinoma, EGFR mutation may be considered as a treatment response predictor for tyrosine kinase inhibitors, instead of a predictor of clinical prognosis.
表皮生长因子受体（EGFR）突变的早期肺腺癌患者的临床病理表现鲜有研究。我们的研究纳入了2014年1月至2017年12月在台湾大学医院就诊的I期和II期肺腺癌患者。根据EGFR突变状态，对临床病理特征和预后进行回顾性分析。1034例患者中，622例（60%）检测到EGFR突变。与无EGFR突变组相比，EGFR突变组65岁以上患者更多（<0.001），非鳞屑状组织学亚型更多（<0.001），癌胚抗原（CEA）水平更高（=0.044），胸膜侵犯（=0.02）和淋巴管侵犯（=0.001）程度更高，组织学分级更高（<0.001），病理分期更晚（=0.022）。多因素分析显示，EGFR突变组和野生型组的无进展生存期（PFS）或总生存期（OS）无显著差异。亚型分析显示，L858R突变的肿瘤具有更为主的鳞屑状组织学类型（=0.019）和更少的淋巴管侵犯（=0.011）。外显子19缺失组和L858R突变组的PFS或OS无显著差异。在早期肺腺癌中，EGFR突变可被视为酪氨酸激酶抑制剂治疗反应的预测指标，而非临床预后的预测指标。
