| Objective: The aim of this study was to retrospectively analyze the efficacy and prognosis factors for patients of stage Ⅳ lung adenocarcinoma with epidermal growth factor receptor(EGFR)mutation,who were treated by EGFR-tyrosine kinase inhibitor(TKI)combined with radiotherapy(RT).Methods: From January 2015 to December 2019,patients of stage Ⅳ lung adenocarcinoma,who were confirmed by pathology or cytology,with EGFR mutation and treated by EGFR-TKI and RT in the Fourth Hospital of Hebei Medical University were enrolled.Data processing and statistical analysis was used SPSS version 21.0 statistical software.Kaplain-Meier method was used to analyze the impact factors of overall survival(OS)and progression-free survival(PFS);multivariate prognostic survival analysis was used COX proportional hazard model.The test level was determined to be statistically significant at P<0.05.Results: The follow-up time was end at 30 December,2020.205 patients with complete clinical and follow-up data were included in this study.There were 86 in males and 119 in females.The median age was 60(range 21-86).clinical stage before treatment: 84 cases(41%)were stage ⅣA,121 cases(59.0%)were stage ⅣB.The status of EGFR mutation were 83 cases(40.5%)with exon 19 deletion mutation,100 cases(48.8%)with exon 21 deletion mutation,and 22 cases(10.7%)with other mutation.The drugs of first-line TKIs was Gefitinib in 73 cases(35.6%),Icotinib in 95 cases(46.3%),Erlotinib in 29 cases(14.1%),Osimertinib in 4 cases(2.0%),others in 4 cases(2.0%).106 cases(51.7%)were treated with EGFR-TKIs alone,37(18.0%)with EGFR-TKIs simultaneous chemotherapy(CT),29(14.1%)with EGFR-TKIs sequential CT,and 33(16.1%)with CT sequential EGFR-TKIs.The median dose of RT was 50Gy(10-66Gy).50 cases(24.4%)received RT during the disease stable(RT was performed at the time of disease was evaluated as CR/PR/SD,Non-PD group),and 155(75.6%)cases received RT after the disease progressed(PD group).PFS1 refers to the time from the first treatment to the first progression of the disease;PFS2 refers to the time from the first treatment to the second progression of the disease.The total response were 3.9%(8/205 cases)with CR,48.3%(99/205 cases)with PR,27.8%(57/205 cases)with SD,and 20.0%(41/205 cases)with PD.The objective response rate(ORR)was 52.2%,and the disease control rate(DCR)was80.0%.For all patients,the median OS was 31.6 months(95% CI: 26.9-36.2),the1-,2-,and 3-year overall survival rates were 83.9%,61.3%,and 38.6%,respectively;the median PFS1 were 14.2 months(95% CI: 12.1-16.4);the 1-,2-,and 3-year PFS1 rates were 56.1%,28.0%,and 16.8%,respectively.the median PFS2 were 25.6 months(95% CI: 21.2-30.0),and the PFS2 rates of 1-,2-,and 3-year were 78.0%,52.4%,and 32.6%,respectively.Univariate analysis showed that,the factors which associated with OS were ages(P=0.033),clinical stage(P=0.007);the timing of RT(P=0.032),dose of RT(P=0.035),types of TKIs(P=0.049),and the total response(P<0.001)were related with PFS1;clinical stage(P=0.023),the total response(P<0.001),types of TKIs(P=0.003)were related with PFS2.The COX multivariate analysis showed that ages,clinical stage,the total response and with/without CT were independent factors for OS;clinical stage,timing of RT,type of TKIs,and the total response were independent factors for PFS1;clinical stage,the the total response and type of TKIs were independent factors for PFS2.Conclusions:1.Patients of stage Ⅳ lung adenocarcinoma with EGFR mutation which treated by TKI combined with RT have a good curative effect.RT was performed during non-PD could increase progression-free survival1.2.For patients with≤60 years old,stage ⅣA,chemotherapy sequential TKIs,and good total response(CR+PR),there were longer overall survival.3.Clinical stage,total response and first-line targeted drugs are related to progression-free survival1 and progression-free survival2. |
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