A real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage III EGFR-mutant adenocarcinoma
Abstract Background The patient population with stage III non-small-cell lung cancer (NSCLC) is heterogeneous, with varying staging characteristics and diverse treatment options. Despite the potential practice-changing implications of randomized controlled trials evaluating the efficacy of periopera...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Cancer |
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| Online Access: | https://doi.org/10.1186/s12885-023-11342-y |
| _version_ | 1827633932817924096 |
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| author | Chieh-Lung Chen Sing-Ting Wang Wei-Chih Liao Chia-Hung Chen Chih-Yen Tu Te-Chun Hsia Wen-Chien Cheng Hung-Jen Chen |
| author_facet | Chieh-Lung Chen Sing-Ting Wang Wei-Chih Liao Chia-Hung Chen Chih-Yen Tu Te-Chun Hsia Wen-Chien Cheng Hung-Jen Chen |
| author_sort | Chieh-Lung Chen |
| collection | DOAJ |
| description | Abstract Background The patient population with stage III non-small-cell lung cancer (NSCLC) is heterogeneous, with varying staging characteristics and diverse treatment options. Despite the potential practice-changing implications of randomized controlled trials evaluating the efficacy of perioperative epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), concerns have been raised due to conflicting overall survival (OS) results. Few real-world studies have examined the survival outcomes of patients with resected EGFR-mutant stage III adenocarcinoma receiving perioperative chemotherapy and EGFR–TKIs. Methods In this retrospective observational study, we enrolled patients with resected stage III adenocarcinoma with EGFR mutations between January 2011 and December 2021. Patients were classified into two groups: perioperative chemotherapy and perioperative EGFR–TKIs. Outcomes and prognostic factors were analyzed using Cox proportional hazards regression analysis. Results Eighty-four patients were enrolled in the analysis. Perioperative EGFR-TKIs led to longer progression-free survival (PFS) than chemotherapy (38.6 versus 14.2 months; p = 0.019). However, only pathological risk factors predicted poor PFS in multivariate analysis. Patients receiving perioperative chemotherapy had longer OS than those receiving EGFR-TKIs (111.3 versus 50.2 months; p = 0.052). Multivariate analysis identified perioperative treatment with EGFR-TKIs as an independent predictor of poor OS (HR: 3.76; 95% CI: 1.22–11.54). Conclusion Our study demonstrates that chemotherapy should be considered in the perioperative setting for high-risk patients, when taking pathological risk factors into consideration, and that optimized sequencing of EGFR–TKIs might be the most critical determinant of OS. |
| first_indexed | 2024-03-09T15:07:06Z |
| format | Article |
| id | doaj.art-e3287c0494444d8d86120f3fa55815dc |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-03-09T15:07:06Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-e3287c0494444d8d86120f3fa55815dc2023-11-26T13:37:14ZengBMCBMC Cancer1471-24072023-09-012311910.1186/s12885-023-11342-yA real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage III EGFR-mutant adenocarcinomaChieh-Lung Chen0Sing-Ting Wang1Wei-Chih Liao2Chia-Hung Chen3Chih-Yen Tu4Te-Chun Hsia5Wen-Chien Cheng6Hung-Jen Chen7Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University HospitalDivision of Hematology and Oncology, Department of Internal Medicine, China Medical University HospitalDivision of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University HospitalDivision of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University HospitalDivision of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University HospitalDivision of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University HospitalDivision of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University HospitalDivision of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University HospitalAbstract Background The patient population with stage III non-small-cell lung cancer (NSCLC) is heterogeneous, with varying staging characteristics and diverse treatment options. Despite the potential practice-changing implications of randomized controlled trials evaluating the efficacy of perioperative epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), concerns have been raised due to conflicting overall survival (OS) results. Few real-world studies have examined the survival outcomes of patients with resected EGFR-mutant stage III adenocarcinoma receiving perioperative chemotherapy and EGFR–TKIs. Methods In this retrospective observational study, we enrolled patients with resected stage III adenocarcinoma with EGFR mutations between January 2011 and December 2021. Patients were classified into two groups: perioperative chemotherapy and perioperative EGFR–TKIs. Outcomes and prognostic factors were analyzed using Cox proportional hazards regression analysis. Results Eighty-four patients were enrolled in the analysis. Perioperative EGFR-TKIs led to longer progression-free survival (PFS) than chemotherapy (38.6 versus 14.2 months; p = 0.019). However, only pathological risk factors predicted poor PFS in multivariate analysis. Patients receiving perioperative chemotherapy had longer OS than those receiving EGFR-TKIs (111.3 versus 50.2 months; p = 0.052). Multivariate analysis identified perioperative treatment with EGFR-TKIs as an independent predictor of poor OS (HR: 3.76; 95% CI: 1.22–11.54). Conclusion Our study demonstrates that chemotherapy should be considered in the perioperative setting for high-risk patients, when taking pathological risk factors into consideration, and that optimized sequencing of EGFR–TKIs might be the most critical determinant of OS.https://doi.org/10.1186/s12885-023-11342-yAdenocarcinomaChemotherapyEpidermal growth factor receptor (EGFR)Stage IIISurgeryTyrosine kinase inhibitor (TKI) |
| spellingShingle | Chieh-Lung Chen Sing-Ting Wang Wei-Chih Liao Chia-Hung Chen Chih-Yen Tu Te-Chun Hsia Wen-Chien Cheng Hung-Jen Chen A real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage III EGFR-mutant adenocarcinoma BMC Cancer Adenocarcinoma Chemotherapy Epidermal growth factor receptor (EGFR) Stage III Surgery Tyrosine kinase inhibitor (TKI) |
| title | A real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage III EGFR-mutant adenocarcinoma |
| title_full | A real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage III EGFR-mutant adenocarcinoma |
| title_fullStr | A real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage III EGFR-mutant adenocarcinoma |
| title_full_unstemmed | A real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage III EGFR-mutant adenocarcinoma |
| title_short | A real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage III EGFR-mutant adenocarcinoma |
| title_sort | real world study comparing perioperative chemotherapy and egfr tyrosine kinase inhibitors for treatment of resected stage iii egfr mutant adenocarcinoma |
| topic | Adenocarcinoma Chemotherapy Epidermal growth factor receptor (EGFR) Stage III Surgery Tyrosine kinase inhibitor (TKI) |
| url | https://doi.org/10.1186/s12885-023-11342-y |
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