三到四期患者或可通过手术延长总生存期

Surgery May Improve Survival After TKI Therapy in Stage IIIB-IV EGFR-Mutant Lung Cancer

根据发表在《肺癌》上的研究，胸腔手术可能会改善对酪氨酸激酶抑制剂 (TKI) 治疗有反应的不可切除的 IIIB-IV 期 EGFR 突变肺腺癌患者的总生存期 (OS)。

该研究表明，在 EGFR-TKI 治疗后接受手术的患者的 OS 明显优于仅继续接受 EGFR-TKI 治疗直至疾病进展的患者。

研究人员使用台湾癌症登记数据库的数据进行了这项基于人群的队列研究。该研究包括 1395 名匹配的患者——手术组 279 名，TKI 单药组 1116 名。

基线时，手术组的平均年龄为 60.20 岁，TKI 单药组的平均年龄为 60.41 岁。每组中超过一半的患者（分别为 57.7% 和 57.2%）是女性。

手术组的平均随访时间为 4.86 年，TKI 单药组为 3.73 年（P <.0001）。

手术组的 5 年 OS 率为 39.77%，单独 TKI 组为 21.97%。与 TKI 单药组相比，手术组全因死亡的调整后风险比 (aHR) 为 0.445（95% CI，0.351-0.564；P <.0001）。

对于年龄小于 65 岁的患者，手术组的 5 年 OS 为 31.17%，TKI 单独组为 18.71%。与单纯 TKI 组相比，手术组全因死亡的 aHR 为 0.492（95% CI，0.379-0.640；P <.0001）。

对于 65 岁或以上的患者，手术组的 5 年 OS 为 61.21%，而单独 TKI 组为 19.74%。与单纯 TKI 组相比，手术组全因死亡的 aHR 为 0.347（95% CI，0.209-0.575；P <.0001）。

研究人员承认这项研究有一些局限性，包括潜在的选择偏差和残留的、无法测量的混杂因素。此外，无法确定胸外科手术引起的并发症，因此与治疗相关的死亡率估计可能存在偏差。

此外，所有患者都是亚洲人，数据库没有提供关于非 EGFR 突变的信息，所有合并症的诊断取决于国际疾病分类、第十次修订、临床修改代码。

Thoracic surgery may improve overall survival (OS) in patients with unresectable stage IIIB-IV EGFR-mutant lung adenocarcinoma who responded to treatment with a tyrosine kinase inhibitor (TKI), according to research published in Lung Cancer.

The study showed that patients who underwent surgery after EGFR-TKI treatment had significantly better OS than patients who continued on EGFR-TKI treatment alone until disease progression.

Researchers conducted this population-based cohort study using data from the Taiwan Cancer Registry Database. The study included 1395 matched patients — 279 in the surgery group and 1116 in the TKI-alone group.

At baseline, the mean age was 60.20 years in the surgery group and 60.41 years in the TKI-alone group. More than half of patients in each group (57.7% and 57.2%, respectively) were women.

The mean follow-up was 4.86 years in the surgery group and 3.73 years in the TKI-alone group (P <.0001).

The 5-year OS rate was 39.77% in the surgery group and 21.97% in the TKI-alone group. The adjusted hazard ratio (aHR) for all-cause death was 0.445 (95% CI, 0.351-0.564; P <.0001) in the surgery group vs the TKI-alone group.

For patients younger than 65 years of age, the 5-year OS was 31.17% in the surgery group and 18.71% in the TKI-alone group. The aHR for all-cause death was 0.492 (95% CI, 0.379-0.640; P <.0001) in the surgery group vs the TKI-alone group.

For patients age 65 or older, the 5-year OS was 61.21% in the surgery group and 19.74% in the TKI-alone group. The aHR for all-cause death was 0.347 (95% CI, 0.209-0.575; P <.0001) in the surgery group vs the TKI-alone group.

The researchers acknowledged a few limitations of this study, including potential selection bias and residual, unmeasured confounding. Additionally, complications caused by thoracic surgery could not be determined, so treatment-related mortality estimates may have been biased.

Furthermore, all patients were Asian, the database did not provide information on non-EGFR mutations, and the diagnoses of all comorbidities were dependent on International Classification of Diseases, Tenth Revision, Clinical Modification codes.