Analysis Of Factors Influencing Survival Of Advanced Non-brain Metastatic Lung Adenocarcinoma Treated With First-line EGFR-TKIs

Background:For patients with advanced non-small cell lung cancer(NSCLC)with egfr-sensitive mutations,first-line use of egfr-receptor tyrosine kinase inhibitors(egfr-tkis)is highly effective,but there are significant differences in progression-free survival(PFS)and overall survival(OS).Some studies have shown that some clinical factors such as metastatic site are one of the important factors affecting prognosis,and brain metastasis is considered as a poor prognostic factor.However,in patients without brain metastasis,the prognostic factors are unclear.In this study,the relationship between different clinical characteristics of NSCLC patients without brain metastasis,the expression of immunotherapy biomarker(pd-l1)and the efficacy of targeted therapy was analyzed to explore the relevant factors that may affect the prognosis.Their potential impact on clinical application was analyzed to better evaluate the efficacy of advanced lung adenocarcinoma patients,and to provide evidence for the early modification of the best treatment regimen for patients with poor efficacy of egfr-tkis and the development of new treatment strategies.Methods:Collection of cases for January 2015-January 2019 visits in nanchang university second affiliated hospital of oncology sensitive EGFR mutations(exon 19 deletions or 21 exon mutations)and receive EGFR TKIs-as a first-line treatment of advanced(stage IIIB or IV),patients with brain metastases from non-small cell lung cancer patients with all the relevant clinical data such as age,gender,ECOG score,smoking status,TNM staging,transfer of organs,PD-L1 expression,treatment and curative effect evaluation,analysis the relationship between clinical factors and PFS.SPSS 24.0 statistical software was used for data processing and statistical analysis.Kaplan-meier method and log-rank test were used for univariate analysis,and survival curves were drawn.Cox regression model was used for multivariate analysis to screen independent risk factors affecting patient survival.P < 0.05 indicated that the difference was statistically significant.Results:1.Among the enrolled patients,39(42%)were male and 55(58%)were female.The age distribution of patients ranged from 40 to 83 years old,and the median age was 63 years old,among which 51 patients were aged 65 years old(54.60%),and 43 patients were aged 65 years old(45.40%).There were 17 smoking patients(18.42%)and 77 non-smoking patients(81.58%).The majority of patients diagnosed with end-stage disease,? B phase 4 cases(3.9%)patients,patients with stage IV 90%;ECOG score was 0-1 in 74 cases(78.94%)and 2 or more in 20 cases(21.06%).The proportion of patients with 19 exon mutations of EGFR gene was slightly higher than that of patients with 21 exon mutations(87 cases(54 cases)and 40 cases(42.76%),respectively).There were 39 cases of single organ metastasis(42.10%)and 55 cases of multiple organ metastasis(57.90%).Among them,35 cases were tested for pd-l1,among which 24(68.57%)were negative and 11(31.43%)were positive.2.RECIST1.1 was evaluated according to the RECIST1.1 criteria.By the end of follow-up,116 of the 152 patients had disease progression and 43 patients had died.The median follow-up time was 21.1 months and the median PFS was 10.94 months.There were 63 patients(41.44%)with PR,80 patients(52.63%)with SD,9 patients with PD(5.93%)without CR.3.Univariate analysis results related to PFS show that: ECOG PS score >1points(7.95 months vs14.29 months,P=0.020),smoking(12.5 months vs 13.5months,P=0.037),liver metastasis(7.45 months vs 13.50 months,P=0.028),pleural effusion(7.45 months vs14.29 months),multi-organ metastasis(10.94 months vs16.52 months,P=0.029),and the best curative effect was SD(10.74 months vs 14.71months).P=0.032)significantly shortened PFS;Patients with positive pd-l1expression(13.14 months VS7.45 months,P=0.561)had an effect on PFS,but the difference was not statistically significant.Lung metastasis(12.55 months vs.14.65 months,P=0.209),bone metastasis(12.55 months vs.14.65 months,P=0.020),adrenal metastasis(15.20 months vs.15.26 months,P=0.462),the differences were not statistically significant.4.Multivariate regression analysis showed that combined pleural effusion(HR=1.715,95%ci: 1.088-2.706,P= 0.020),multiorgan metastasis(HR=1.846,95%ci: 1.242-2.744,P=0.002)and the best response was SD(HR=0.591,95%ci: 0.399-0.875,P= 0.009)were independent predictors of PFS.Conclusion:1.m PFS in patients with advanced EGFR-sensitive mutant lung adenocarcin-oma treated with first-line egfr-tkis of the first generation was 10.94 months.2.The combination of pleural effusion,multi-organ metastasis and the best response were related to SD and PFS,which were independent clinical predictors of PFS.