Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 404327, Taiwan.
Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, 404327, Taiwan.
BMC Cancer. 2023 Sep 11;23(1):847. doi: 10.1186/s12885-023-11342-y.
The patient population with stage III non-small-cell lung cancer (NSCLC) is heterogeneous, with varying staging characteristics and diverse treatment options. Despite the potential practice-changing implications of randomized controlled trials evaluating the efficacy of perioperative epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), concerns have been raised due to conflicting overall survival (OS) results. Few real-world studies have examined the survival outcomes of patients with resected EGFR-mutant stage III adenocarcinoma receiving perioperative chemotherapy and EGFR-TKIs.
In this retrospective observational study, we enrolled patients with resected stage III adenocarcinoma with EGFR mutations between January 2011 and December 2021. Patients were classified into two groups: perioperative chemotherapy and perioperative EGFR-TKIs. Outcomes and prognostic factors were analyzed using Cox proportional hazards regression analysis.
Eighty-four patients were enrolled in the analysis. Perioperative EGFR-TKIs led to longer progression-free survival (PFS) than chemotherapy (38.6 versus 14.2 months; p = 0.019). However, only pathological risk factors predicted poor PFS in multivariate analysis. Patients receiving perioperative chemotherapy had longer OS than those receiving EGFR-TKIs (111.3 versus 50.2 months; p = 0.052). Multivariate analysis identified perioperative treatment with EGFR-TKIs as an independent predictor of poor OS (HR: 3.76; 95% CI: 1.22-11.54).
Our study demonstrates that chemotherapy should be considered in the perioperative setting for high-risk patients, when taking pathological risk factors into consideration, and that optimized sequencing of EGFR-TKIs might be the most critical determinant of OS.
III 期非小细胞肺癌（NSCLC）患者人群具有异质性，其分期特征和治疗选择各不相同。尽管评估围手术期表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）疗效的随机对照试验具有改变实践的潜力，但由于总生存（OS）结果存在冲突，人们对此仍存在担忧。很少有真实世界的研究探讨接受围手术期化疗和 EGFR-TKIs 治疗的 EGFR 突变型 III 期腺癌切除患者的生存结局。
在这项回顾性观察性研究中，我们纳入了 2011 年 1 月至 2021 年 12 月期间接受 EGFR 突变型 III 期腺癌切除术的患者。患者被分为两组：围手术期化疗和围手术期 EGFR-TKIs。采用 Cox 比例风险回归分析评估结局和预后因素。
共有 84 例患者纳入分析。与化疗相比，围手术期 EGFR-TKIs 可使无进展生存期（PFS）更长（38.6 与 14.2 个月；p=0.019）。然而，仅病理危险因素在多变量分析中预测了较差的 PFS。接受围手术期化疗的患者的 OS 长于接受 EGFR-TKIs 的患者（111.3 与 50.2 个月；p=0.052）。多变量分析确定围手术期使用 EGFR-TKIs 是 OS 不良的独立预测因素（HR：3.76；95%CI：1.22-11.54）。
我们的研究表明，在考虑病理危险因素的情况下，对于高危患者，围手术期应考虑化疗，并且 EGFR-TKIs 的最佳序贯治疗可能是 OS 的最关键决定因素。
