Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Cancer Rep (Hoboken). 2024 Sep;7(9):e70004. doi: 10.1002/cnr2.70004.
Mutations in the epidermal growth factor receptor (EGFR) gene are the most common targetable gene alterations in non-small cell lung cancer (NSCLC). In Japan, approximately 40% of patients who undergo surgical resection for non-squamous NSCLC have EGFR mutations. However, no long-term studies have been conducted including a large number of EGFR-positive NSCLC patients with postoperative recurrence (PR).
We conducted a retrospective observational study of the data of EGFR-positive NSCLC patients with PR who had undergone surgery at the Shizuoka Cancer Center between October 2002 and November 2017. We evaluated post-recurrence overall survival (PRS) and postoperative overall survival (POS) using the Kaplan-Meier method and identify any associations between the clinical variables at recurrence and PRS using univariate and multivariate analysis.
We enrolled 162 patients. The median observation time for PRS was 4.95 years (range, 0.82-13.25) and POS was 5.81 years (range, 2.84-16.71). The median PRS was 5.17 years (95% confidence interval [CI], 3.90-5.61) and POS was 7.07 years (95% CI, 5.88-8.01). Univariate analysis identified male sex (median PRS: 3.32 vs. 5.39 years; p < 0.05), bone metastasis (median PRS: 2.43 vs. 5.33 years; p < 0.05), and central nervous system (CNS) metastasis (median PRS: 3.05 vs. 5.39 years; p < 0.05) and multivariate analysis identified bone metastasis (hazard ratio [HR], 2.01; 95% CI, 1.23-3.28; p < 0.05) and CNS metastasis (HR, 1.84; 95% CI, 1.14-2.98; p < 0.05) as poor prognostic factors. The pattern of recurrence (oligo vs. non-oligo recurrence) was not a prognostic factor. Logistic regression analysis revealed the association between sex and the presence bone/CNS metastasis at recurrence.
Our data may help visualize future prospects and determine the timing of osimertinib initiation. New treatment strategies need to be developed for patients with bone/CNS metastasis at the first recurrence.
表皮生长因子受体 (EGFR) 基因突变是非小细胞肺癌 (NSCLC) 中最常见的可靶向基因改变。在日本，大约 40%接受非鳞状 NSCLC 手术切除的患者存在 EGFR 突变。然而，目前尚无包括大量术后复发 (PR) 的 EGFR 阳性 NSCLC 患者的长期研究。
我们对 2002 年 10 月至 2017 年 11 月在静冈癌症中心接受手术的 EGFR 阳性 NSCLC 患者 PR 数据进行了回顾性观察性研究。我们使用 Kaplan-Meier 方法评估 PRS 和 POS，并使用单变量和多变量分析确定复发时的临床变量与 PRS 之间的任何关联。
我们纳入了 162 名患者。PRS 的中位观察时间为 4.95 年（范围，0.82-13.25），POS 为 5.81 年（范围，2.84-16.71）。PRS 的中位值为 5.17 年（95%置信区间 [CI]，3.90-5.61），POS 为 7.07 年（95%CI，5.88-8.01）。单变量分析发现男性（PRS 中位数：3.32 年 vs. 5.39 年；p<0.05）、骨转移（PRS 中位数：2.43 年 vs. 5.33 年；p<0.05）和中枢神经系统 (CNS) 转移（PRS 中位数：3.05 年 vs. 5.39 年；p<0.05），多变量分析发现骨转移（HR，2.01；95%CI，1.23-3.28；p<0.05）和 CNS 转移（HR，1.84；95%CI，1.14-2.98；p<0.05）是预后不良的因素。复发模式（寡复发与非寡复发）不是预后因素。Logistic 回归分析显示了性别与复发时骨/CNS 转移存在之间的关系。
我们的数据可能有助于预测未来的前景并确定奥希替尼起始时间。需要为首次复发时存在骨/CNS 转移的患者制定新的治疗策略。
