Onodera Ken, Yokota Isao, Matsumura Yuki, Hayasaka Kazuki, Shiono Satoshi, Abe Jiro, Notsuda Hirotsugu, Sakurada Akira, Suzuki Hiroyuki, Okada Yoshinori
Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.
Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
J Thorac Dis. 2023 Dec 30;15(12):6534-6543. doi: 10.21037/jtd-23-1323. Epub 2023 Dec 4.
The ADAURA trial reported that osimertinib improved overall survival (OS) as an adjuvant chemotherapy for pathological stage IB-IIIA epidermal growth factor receptor (EGFR) mutant lung cancer compared with a placebo. Currently, platinum-based adjuvant chemotherapy is the standard treatment for patients with or without EGFR mutations. This study aimed to evaluate the efficacy of platinum-based adjuvant chemotherapy in patient with stage II-IIIA EGFR mutant lung adenocarcinoma.
We collected the medical records of consecutive patients who underwent surgical resection for lung adenocarcinoma between 2005 and 2012 at the four participating institutions. The data of 173 patients with different EGFR mutation status were retrospectively evaluated to determine the efficacy of platinum-based adjuvant chemotherapy for OS and recurrence-free survival (RFS). We further analyzed OS using the inverse probability of treatment weighting method with propensity scores.
The median age was 69 years (range, 45-85 years); 95 (54.9%) were male and 74 (42.8%) had EGFR mutations. A total of 43 patients with EGFR mutants (58.1%) and 43 patients with wild-type EGFR tumors (43.4%) received platinum-based adjuvant chemotherapy. No differences in RFS and OS were observed between EGFR mutant and wild-type EGFR in lung adenocarcinoma without adjuvant therapy. However, wild-type EGFR showed an improvement in OS with platinum-based adjuvant chemotherapy in inverse probability of treatment weighting analysis, whereas those with EGFR mutations showed no significant difference in OS between the surgery-only group and the adjuvant group. The deletion of exon 19 and exon 21 L858R point mutation showed no significant differences in OS between the surgery-only group and the adjuvant group, respectively. The hazard ratio (HR) exceeded 1 for uncommon EGFR mutations.
Platinum-based adjuvant chemotherapy may be less effective for EGFR-mutant lung adenocarcinoma, regardless of the mutation type.
ADAURA试验报告称，与安慰剂相比，奥希替尼作为病理分期为IB-IIIA期表皮生长因子受体（EGFR）突变型肺癌的辅助化疗可改善总生存期（OS）。目前，铂类辅助化疗是有或无EGFR突变患者的标准治疗方法。本研究旨在评估铂类辅助化疗在II-IIIA期EGFR突变型肺腺癌患者中的疗效。
我们收集了2005年至2012年期间在四个参与机构接受肺腺癌手术切除的连续患者的病历。回顾性评估173例不同EGFR突变状态患者的数据，以确定铂类辅助化疗对OS和无复发生存期（RFS）的疗效。我们使用倾向评分的治疗权重逆概率方法进一步分析OS。
中位年龄为69岁（范围45-85岁）；95例（54.9%）为男性，74例（42.8%）有EGFR突变。共有43例EGFR突变患者（58.1%）和43例EGFR野生型肿瘤患者（43.4%）接受了铂类辅助化疗。在未接受辅助治疗的肺腺癌中，EGFR突变型和野生型EGFR之间在RFS和OS方面未观察到差异。然而，在治疗权重逆概率分析中，野生型EGFR在铂类辅助化疗后OS有所改善，而EGFR突变患者在单纯手术组和辅助组之间的OS无显著差异。外显子19缺失和外显子21 L858R点突变在单纯手术组和辅助组之间的OS分别无显著差异。罕见EGFR突变的风险比（HR）超过1。
无论突变类型如何，铂类辅助化疗对EGFR突变型肺腺癌可能疗效较差。
