PDF(Pubmed)
Abstract：
Despite the widespread application of next-generation sequencing (NGS) in advanced lung adenocarcinoma, its impact on survival and the optimal timing for the examination remain uncertain. This cohort study included advanced lung adenocarcinoma patients who underwent NGS testing. We categorized patients into four groups: Group 1: treatment-naïve, upfront NGS; Group 2: Treatment-naïve, exclusionary EGFR/ALK/ROS1; Group 3: post-treatment, no known EGFR/ALK/ROS1; Group 4: known driver mutation and post-TKI treatment. A total of 424 patients were included. There were 128, 126, 90, and 80 patients in Groups 1, 2, 3, and 4, respectively. In Groups 1, 2, 3, and 4, targetable mutations were identified in 76.6%, 49.2%, 41.1%, and 33.3% of the patients, respectively (p < 0.001). Mutation-targeted treatments were applied in 68.0%, 15.1%, 27.8%, and 22.5% of the patients, respectively (p < 0.001). In the overall population, patients receiving mutation-targeted treatments exhibited significantly longer overall survival (OS) (aHR 0.54 [95% CI 0.37-0.79], p = 0.001). The most profound benefit was seen in the Group 1 patients (not reached vs. 40.4 months, p = 0.028). The median OS of patients with mutation-targeted treatments was also significantly longer among Group 2 patients. The median post-NGS survival of patients receiving mutation-targeted treatments was numerically longer in Group 3 and Group 4 patients. In conclusion, mutation-targeted therapy is associated with a favorable outcome. However, the opportunities of NGS-directed treatment and the survival benefits of mutation-targeted treatment were various among different populations.
摘要：
尽管下一代测序（NGS）在晚期肺腺癌中的广泛应用，它对生存的影响和检查的最佳时机仍然不确定。这项队列研究包括接受NGS检测的晚期肺腺癌患者。我们将患者分为四组：第1组：未治疗，前期NGS；第2组：幼稚治疗，排除性EGFR/ALK/ROS1；第3组：治疗后，无已知EGFR/ALK/ROS1；第4组：已知驱动突变和TKI后治疗。共纳入424例患者。在第1、2、3和4组中分别有128、126、90和80名患者。在第1、2、3和4组中，76.6%的人发现了可靶向突变，49.2%,41.1%,33.3%的病人，分别(p<0.001)。68.0%采用突变靶向治疗,15.1%,27.8%,22.5%的病人,分别(p<0.001)。在总人口中,接受突变靶向治疗的患者表现出显著更长的总生存期(OS)(aHR0.54[95%CI0.37-0.79]，p=0.001)。在第1组患者中看到了最深远的益处(未达到vs.40.4个月，p=0.028)。在第2组患者中，采用突变靶向治疗的患者的中位OS也明显更长。在第3组和第4组患者中，接受靶向突变治疗的患者的NGS后生存期中位数在数值上更长。总之,突变靶向治疗与良好的预后相关.然而,NGS导向治疗的机会和突变靶向治疗的生存获益在不同人群中不同.
