Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
Ann Thorac Surg. 2024 Jun;117(6):1111-1119. doi: 10.1016/j.athoracsur.2023.05.031. Epub 2023 Jun 22.
This study investigated the prognostic impact of epidermal growth factor receptor (EGFR) mutation in clinical stage I lung adenocarcinoma patients.
Data for 952 patients who received surgical resection and underwent detection of oncogenic driver mutations were retrospectively collected. Recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared using the log-rank test. The adjusted hazard ratio (aHR) with 95% CI of the prognosticator was calculated by Cox proportional hazards model, and cumulative incidence function was measured by competing risk regression model.
EGFR mutation was detected in 581 patients (61.0%) and was more frequent in women (63.9%), nonsmokers (85.5%), and those with ground-glass nodules (GGNs; 56.6%). EGFR mutation was not associated with recurrence and death in the entire cohort or GGN cohort. However, for patients with radiologic pure-solid appearance, EGFR mutation was an independent risk factor for RFS (aHR, 1.623; 95% CI, 1.192-2.210) and distant recurrence (aHR, 1.863; 95% CI, 1.311-2.650), but not OS. Subsequently, subgroup analysis based on EGFR mutation subtypes, including exon 19 deletions (19-Del), exon 21 L858R substitution (L858R), and rare mutations in patients with radiologic pure-solid appearance, revealed that all 3 subtypes have poorer RFS (19-Del: aHR, 1.424; 95% CI, 0.991-2.047; L858R: aHR, 1.708; 95% CI, 1.172-2.490; rare mutations: aHR, 2.500; 95% CI, 1.400-4.465) and higher prevalent distant recurrence (19-Del: aHR, 1.595; 95% CI, 1.061-2.400; L858R: aHR, 2.073; 95% CI, 1.371-3.140; rare mutations: aHR, 2.657; 95% CI, 1.397-5.050) compared with wild-type.
In clinical stage I lung adenocarcinoma, EGFR mutation was associated with worse RFS and higher prevalent distant recurrence in patients with radiologic pure-solid appearance but not in patients with GGN.
本研究旨在探讨表皮生长因子受体（EGFR）突变对临床 I 期肺腺癌患者的预后影响。
回顾性收集了 952 例接受手术切除并进行致癌驱动基因突变检测的患者的数据。采用 Kaplan-Meier 法估计无复发生存期（RFS）和总生存期（OS），并采用对数秩检验进行比较。通过 Cox 比例风险模型计算预后因素的调整后风险比（aHR）及其 95%置信区间（CI），并通过竞争风险回归模型测量累积发生率函数。
在 952 例患者中，检测到 581 例（61.0%）EGFR 突变，其中女性（63.9%）、不吸烟者（85.5%）和磨玻璃结节（GGN；56.6%）患者中 EGFR 突变更为常见。EGFR 突变与整个队列或 GGN 队列的复发和死亡无关。然而，对于影像学表现为纯实性的患者，EGFR 突变是 RFS（aHR，1.623；95%CI，1.192-2.210）和远处复发（aHR，1.863；95%CI，1.311-2.650）的独立危险因素，但与 OS 无关。随后，基于 EGFR 突变亚型（包括外显子 19 缺失（19-Del）、外显子 21 L858R 取代（L858R）和影像学表现为纯实性患者的罕见突变）的亚组分析显示，所有 3 种亚型的 RFS 均较差（19-Del：aHR，1.424；95%CI，0.991-2.047；L858R：aHR，1.708；95%CI，1.172-2.490；罕见突变：aHR，2.500；95%CI，1.400-4.465），远处复发更为常见（19-Del：aHR，1.595；95%CI，1.061-2.400；L858R：aHR，2.073；95%CI，1.371-3.140；罕见突变：aHR，2.657；95%CI，1.397-5.050）。
在临床 I 期肺腺癌中，EGFR 突变与影像学表现为纯实性的患者的 RFS 较差和远处复发更为常见相关，但与 GGN 患者无关。
