背景:具有表皮生长因子受体(EGFR)突变(Mt)的病理性IB-IIIA期肺腺癌即使在完全切除后也具有很高的复发率。然而,关于Mt复发的危险因素的报道很少。本研究旨在分析与无EGFR突变的IB-IIIA期原发性肺腺癌患者无复发生存期(RFS)相关的临床病理因素。
方法:接受Mt治愈性手术的患者(n=208)具有EGFR外显子21L858R点突变或EGFR外显子19缺失突变和EGFR突变野生型肺腺癌(Wt,包括2010年1月至2020年12月之间的n=358)。接受EGFR-酪氨酸激酶抑制剂辅助治疗的患者被排除在外。使用多变量Cox回归分析RFS的预后因素。
结果:Mt和Wt组的5年RFS率分别为43.5和52.3%,分别(p=0.907)。Mt组RFS的预后因素包括吸烟史(风险比[HR],1.49;p=0.049),血管浸润(HR,1.84;p=0.023),和淋巴结转移(HR,1.96;p=0.005)。然而,辅助化疗不是预后因素(HR,1.02;p=0.906)。相比之下,正电子发射断层扫描(PET)最大标准化摄取值(SUV)≥6.0(HR,1.53;p=0.042),淋巴管浸润(HR,1.54;p=0.036),淋巴结转移(HR,1.79;p=0.002),和辅助化疗(HR,0.60;p=0.008)是Wt组RFS的预后因素。
结论:IB-IIIA期原发性肺腺癌RFS的预后因素因表皮生长因子受体突变状态而异。辅助化疗对RFS的影响也因EGFR突变状态而异。
BACKGROUND: Pathological stage IB-IIIA lung adenocarcinoma with an epidermal growth factor receptor (EGFR) mutation (Mt) has a high recurrence rate even after complete resection. However, there have been few reports on the risk factors for Mt recurrence. This study aimed to analyze the clinicopathological factors related to the relapse-free survival (RFS) of patients with pathological stage IB-IIIA primary lung adenocarcinoma with and without an EGFR mutation.
METHODS: Patients who underwent curative surgery for Mt (n = 208) harboring the EGFR exon 21 L858R point mutation or EGFR exon 19 deletion mutation and EGFR mutation wild-type lung adenocarcinoma (Wt, n = 358) between January 2010 and December 2020 were included. Patients who received adjuvant EGFR-tyrosine kinase inhibitors were excluded. The prognostic factors for RFS were analyzed using a multivariable Cox regression analysis.
RESULTS: The 5-year RFS rates in the Mt and Wt groups were 43.5 and 52.3%, respectively (p = 0.907). Prognostic factors for RFS in the Mt group included smoking history (hazard ratio [HR], 1.49; p = 0.049), blood vessel invasion (HR, 1.84; p = 0.023), and lymph node metastasis (HR, 1.96; p = 0.005). However, adjuvant chemotherapy was not a prognostic factor (HR, 1.02; p = 0.906). In contrast, positron emission tomography (PET) max standardized uptake value (SUV) ≥ 6.0 (HR, 1.53; p = 0.042), lymphatic vessel invasion (HR, 1.54; p = 0.036), lymph node metastasis (HR, 1.79; p = 0.002), and adjuvant chemotherapy (HR, 0.60; p = 0.008) were prognostic factors for RFS in the Wt group.
CONCLUSIONS: Prognostic factors for RFS in stage IB-IIIA primary lung adenocarcinoma differ by epidermal growth factor receptor mutation status. The impact of adjuvant chemotherapy on RFS also differed by EGFR mutation status.