Prognostic Impact of Postoperative Recurrence in Patients With Epidermal Growth Factor Receptor–Positive Non-Small Cell Lung Cancer

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-09-08 DOI:10.1002/cnr2.70004

Meiko Morita, Akira Ono, Motoki Sekikawa, Kosei Doshita, Keita Miura, Hiroaki Kodama, Michitoshi Yabe, Noboru Morikawa, Yuko Iida, Nobuaki Mamesaya, Haruki Kobayashi, Ryo Ko, Kazushige Wakuda, Hirotsugu Kenmotsu, Tateaki Naito, Haruyasu Murakami, Mitsuhiro Isaka, Yasuhisa Ohde, Toshiaki Takahashi

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Abstract

Background

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).

Methods

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.

Results

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.

Conclusion

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.

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表皮生长因子受体阳性非小细胞肺癌患者术后复发的预后影响

背景：表皮生长因子受体（EGFR）基因突变是非小细胞肺癌（NSCLC）最常见的靶向基因改变。在日本，接受非鳞状 NSCLC 手术切除的患者中约有 40% 存在表皮生长因子受体基因突变。然而，目前还没有包括大量 EGFR 阳性 NSCLC 患者术后复发（PR）的长期研究：我们对 2002 年 10 月至 2017 年 11 月期间在静冈癌症中心接受手术治疗的 EGFR 阳性 NSCLC PR 患者的数据进行了回顾性观察研究。我们采用Kaplan-Meier法评估了复发后总生存期（PRS）和术后总生存期（POS），并采用单变量和多变量分析确定了复发时临床变量与PRS之间的关联：我们共招募了 162 名患者。PRS的中位观察时间为4.95年（范围为0.82-13.25），POS的中位观察时间为5.81年（范围为2.84-16.71）。PRS 的中位观察时间为 5.17 年（95% 置信区间 [CI]，3.90-5.61），POS 为 7.07 年（95% 置信区间 [CI]，5.88-8.01）。单变量分析确定了男性性别（PRS 中位数：3.32 对 5.39 年；P 结论：我们的数据有助于展望未来，并确定奥希替尼的起始时机。需要为首次复发的骨/中枢神经系统转移患者制定新的治疗策略。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.