Impact of distinct pathological subtypes on the efficacy and prognosis of targeted therapy in EGFR-sensitive mutant lung adenocarcinoma patients
Objective To evaluate the efficacy and prognosis of targeted treatment in lung adenocarcinoma patients with dif-ferent pathological subtypes of epidermal growth factor receptor(EGFR)sensitive mutations,provide references for clini-cal practices.Methods The data of 210 lung cancer patients who received targeted therapy(TKI)in the Shandong Cancer Hospital and the Zibo First Hospital from July 1,2012,to October 31,2017,were retrospected.Among them,there were 91 males and 119 females,with 86 patients being under the age of 60 and 124 patients older.All patients pres-ented 19-Del or L858R sensitive mutations through gene testing,with pathologic type as lung adenocarcinoma.According to different pathologic subtypes,patients were divided into acinar type(19 cases),adenoid type(150 cases),papillary type(16 cases),solid type(13 cases),and micropapillary type(12 cases).The primary endpoint was progression-free survival time(PFS),and the secondary endpoint was overall survival time(OS).Single factor survival analysis utilized Kaplan-Meier method and Log-rank test to evaluate the patients'PFS and OS and to plot survival curves.The Cox propor-tional hazards regression analysis was used for multi-factor analysis to explore prognostic influencing factors.Results A-mong the 210 patients,53 survived,and 157 died.Median PFS was 36.6 months(acinar type),20.0 months(adenoid type),16.0 months(papillary type),5.0 months(solid type),12.3 months(micropapillary type),with significant sta-tistical difference,P＜0.001.While the median OS was 60.0 months(acinar type),39.5 months(adenoid type),58.0 months(papillary type),12.0 months(solid type),41.0 months(micropapillary type),showing no statistically signifi-cant difference,P=0.06.Multi-factor regression analysis impacting PFS:Compared with acinar type,there were signifi-cant differences in progression risks in adenoid type,solid type and micropapillary type(adenoid type:HR=1.72,95％CI was 1.04-2.84,P=0.035;solid type:HR=16.49,95％CI was 7.50-36.24,P＜0.001;micropapillary type:HR=2.27,95％CI was 1.04-4.95,P=0.039).Multi-factor regression analysis impacting OS:Compared to acinar type,the death risk of solid type was 3.38 times of it,HR=3.38,95％CI was 1.41-8.12,P=0.006.Conclusion After TKI treatment in EGFR sensitive mutation patients,adenoid type,solid type and micropapillary type are pathologic subtypes indicating inferior prognosis of PFS,solid type indicates inferior prognosis of OS,which can be utilized to pre-dict the efficacy of targeted therapy.
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