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Positive EGFR mutation status is a risk of recurrence in pN0-1 lung adenocarcinoma when combined with pathological stage and histological subtype: A retrospective multi-center analysis.
Lung Cancer ( IF 5.3 ) Pub Date : 2020-01-30 , DOI: 10.1016/j.lungcan.2020.01.018
Masaoki Ito 1 , Yoshihiro Miyata 1 , Yasuhiro Tsutani 1 , Hiroyuki Ito 2 , Haruhiko Nakayama 2 , Kentaro Imai 3 , Norihiko Ikeda 3 , Morihito Okada 1
Affiliation  

OBJECTIVES Recurrence risk of resected lung adenocarcinoma is represented by pathological stage (pStage), histological subtype, and potentially by EGFR mutation. However, the relationship among these factors and their combined impact on prognosis are unclear. MATERIALS AND METHODS Using a multicenter database, we retrospectively investigated the prognostic impact of EGFR mutation status in relation to pStage and histological subtype in resected pN0-1M0 lung adenocarcinoma. RESULTS Among 1155 pN0-1M0 adenocarcinoma cases, pStage 0 and IA1-IB were confirmed predominantly in EGFR-positive cases. AIS, MIA, and lepidic predominant adenocarcinoma were also more frequently found in EGFR-positive cases and showed no/little recurrence regardless of EGFR mutation status. The 5-year recurrence-free survival (RFS) of papillary, acinar, solid, and micropapillary predominant adenocarcinoma was stratified by pStage (IA1-IB, IIA-IIIA) or histological malignant subtype (intermediate or high malignant subtype), and more finely subdivided by EGFR mutation status. Positive EGFR mutation cases showed worse RFS in both classifications. Low malignant subtype and pStage IA1-IB intermediate malignant subtype showed low frequency of recurrence. Whereas, in pStage IA1-IB high malignant subtype and pStage IIA-IIIA cases, EGFR-positive cases showed poorer 5-year RFS than EGFR-negative (49.6% and 75.6%, respectively, hazard ratio [HR] = 1.84, 95% CI = 1.38-7.42, p <  0.01) and multivariate analysis indicated positive EGFR mutation status was significantly related to poorer PRF (HR = 2.005, 95% CI = 1.029-3.906, p =  0.041). CONCLUSION EGFR mutation harbored primarily in early-stage or low-malignant histological subtypes with no/little recurrence. In pN0-1M0 adenocarcinoma with higher risk of recurrence, positive EGFR mutation cases showed worse RFS. EGFR mutation status enables better stratification of recurrence risk when considering pStage and histological malignant subtype.

中文翻译:

结合病理分期和组织学亚型,EGFR阳性突变状态是pN0-1肺腺癌复发的风险:一项回顾性多中心分析。

目的切除的肺腺癌的复发风险由病理分期(pStage),组织学亚型和可能由EGFR突变代表。然而,这些因素之间的关系及其对预后的综合影响尚不清楚。材料和方法我们使用多中心数据库回顾性研究了EGFR突变状态与切除的pN0-1M0肺腺癌中pStage和组织学亚型相关的预后影响。结果在1155例pN0-1M0腺癌病例中,pStage 0和IA1-IB主要在EGFR阳性病例中被证实。在EGFR阳性病例中,也更经常发现AIS,MIA和鳞状上皮性腺癌,无论EGFR突变状态如何,其均无/少复发。乳头状,腺泡状,固体,微乳头状腺癌按pStage(IA1-IB,IIA-IIIA)或组织学恶性亚型(中度或高度恶性亚型)分层,并按EGFR突变状态细分。EGFR突变阳性病例在两种分类中均显示较差的RFS。低度恶性亚型和pStage IA1-IB中度恶性亚型显示低复发频率。而在pStage IA1-IB高恶性亚型和pStage IIA-IIIA病例中,EGFR阳性病例的5年RFS比EGFR阴性病例差(分别为49.6%和75.6%,危险比[HR] = 1.84、95% CI = 1.38-7.42,p <0.01),多因素分析表明EGFR突变阳性与PRF差显着相关(HR = 2.005,95%CI = 1.029-3.906,p = 0.041)。结论EGFR突变主要存在于早期或低恶性组织学亚型中,无/很少复发。在具有较高复发风险的pN0-1M0腺癌中,EGFR突变阳性病例的RFS较差。考虑到pStage和组织学恶性亚型时,EGFR突变状态可以更好地将复发风险分层。
更新日期:2020-01-31
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