Real-world Study: Prognosis Of Patients With Stage Ⅳ EGFR-positive Lung Adenocarcinoma As A Result Of Different Sequences Of Targeted And Chemotherapy Drugs

Objective:By collecting gender,age,smoking history,BMI,KPS,presence of brain metastases,treatment modality(initial targeted therapy followed by sequential chemotherapy and initial chemotherapy followed by sequential targeted therapy)from stage Ⅳ Epidermal growth factor receptor(EGFR)-positive lung adenocarcinoma patients.To investigate the relationship between different sequences of EGFR tyrosine kinase inhibitors(EGFR-TKI)and chemotherapy drugs in the overall survival(OS)of stage Ⅳ EGFR-positive patients,to provide a basis for individualized clinical treatment of stage Ⅳ EGFR-positive lung adenocarcinoma.Methods:Patients attending the Affiliated Hospital of Chengde Medical College from June 2015 to June 2019 were retrospectively analyzed,and 167 patients with stage Ⅳ EGFR-positive lung adenocarcinoma were finally selected after screening by inclusion and exclusion criteria.Basic information(gender,age,smoking history and smoking index,BMI,KPS),clinical information(pathology,EGFR mutation,presence of brain metastases),treatment modality(sequence of targeted drugs and chemotherapy drugs,the cycle of chemotherapy drugs,whether to use bevacizumab,whether to use radiotherapy)were collected.Patients’ OS is followed up through electronic medical record viewing or telephone follow-up visits,with a follow-up deadline of September 2020.According to the order of application of targeted drugs and chemotherapeutic drugs,they were divided into targeted drug sequential chemotherapy group(initial targeted group)and chemotherapeutic drug sequential targeted drug group(initial chemotherapy group),and the rest were grouped according to different information.The data were finally processed statistically by SPSS 26.0(Statistical Product and Service Solutions 26.0)statistical software.The Wilcoxon test or Kruskal-Wallis H test was applied to compare whether there was any difference in median OS between groups.The Kaplan-Meier method was used to plot survival curves and calculate survival rates at 1,2,and 3 years,and the Log-rank test was used to compare survival rates between groups.The χ2/Fisher test compares whether there is a difference between treatment modality groups.Cox proportional risk models were applied for the univariate and multifactorial analysis of risk prognostic factors in patients with stage Ⅳ EGFR-positive lung adenocarcinoma,and all data results were considered statistically significant at P < 0.05.Results:1 A total of 167 patients were included in the study,with a median overall survival(m OS)of 23 months.There were statistically significant differences in m OS between the groups of gender,age,smoking history,presence of brain metastases and whether or not bevacizumab was applied;there were no significant differences in m OS between the initial targeted group and the initial chemotherapy group,and there were no statistically significant differences in m OS between the groups of BMI,KPS and whether or not radiotherapy was administered.2 All patients’ 1-year,2-year,and 3-year survival rates were 91.02%,46.33%,and 15.11%.There were statistically significant differences in survival rates between the groups of gender,smoking history,BMI,presence of brain metastases and whether bevacizumab was applied;there were no differences in survival rates between the initial targeted group and the initial chemotherapy group;there were no statistically significant differences in survival rates between the groups of age,KPS.3 Univariate analysis showed that gender,smoking history,BMI,presence of brain metastases and application of bevacizumab were associated with prognosis in patients with stage Ⅳ EGFR-positive adenocarcinoma(P <0.05),and the difference was statistically significant.When the factors were subjected to multifactorial analysis,the results showed that presence of brain metastases and whether or not bevacizumab was applied were an independent prognostic factor in patients with stage Ⅳ EGFR-positive lung adenocarcinoma.Conclusion:1 The different sequential order of targeted drugs and chemotherapy drugs did not effect on OS and 1-,2-,and 3-year survival rates in stage Ⅳ EGFR-positive lung adenocarcinoma patients.2 Regardless of the sequence of targeted drugs and chemotherapy agents,bevacizumab improves the overall survival of patients with stage Ⅳ EGFR-positive lung adenocarcinoma as long as it is applied during chemotherapy.3 Gender,smoking history,BMI,presence of brain metastases and the use of bevacizumab were associated with the prognosis of patients with stage Ⅳ EGFR-positive lung adenocarcinoma.The presence of brain metastases and the use of bevacizumab were independent factors affecting the prognosis of patients with stage Ⅳ RGFR-positive lung adenocarcinoma.