| Purpose:In patients with non-small cell lung cancer(NSCLC)carrying KRAS mutations,survival differences among patients with different KRAS mutation status are unclear.Studies have shown that patients with advanced non-small cell lung cancer with KRAS G12 C mutation seem to have better survival than patients with KRAS non-G12C;Studies have also found no significant differences in PFS or OS between patients with KRAS G12 C and KRAS non-G12 C mutation tumors or between patients with G12 C,G12V,G12 D and G12 A mutation tumors.This study retrospectively analyzed the efficacy,survival,and prognosis of KRAS G12 C mutation versus KRAS non-G12 c mutation and KRAS G12 C mutation and G12 C co-mutation in patients with non-small cell lung cancer.Methods:This study retrospectively analyzed NSCLC patients with KRAS mutation treated in the First Affiliated Hospital of Nanchang University from December 2019 to December 2022.These patients had advanced and unresectable local advanced stage.First-line treatment was chemotherapy combined with immunotherapy combined with anti-angiogenesis therapy,chemotherapy combined with immunotherapy,and chemotherapy combined with anti-angiogenesis therapy,respectively.Objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),and overall survival(OS)of solid tumors were evaluated using World Health Organization(WHO)Criteria for Evaluation of Efficacy in solid Tumors(RECIST).The relationship between KRAS mutation status,clinical features and therapeutic effect was statistically analyzed by Fisher’s exact test or Chi-square test.Kaplan-Meier method was used to analyze PFS and OS,and their survival curves were developed.Log-rank test was used to compare PFS and OS in KRAS G12 C mutant group,KRAS non-G12 c mutant group,KRAS G12 C mutant group and G12 C co-mutant group.The Cox proportional risk model was used to eliminate confounding factors and analyze the prognostic value.Results were expressed in terms of hazard ratio(HR),95% confidence interval,and P-value.A p value <0.05(double-tailed)was defined as a statistically significant difference.Result:The ORR in the KRAS G12 C group was 56.1% higher than that in the KRAS non-G12 C group(50.9%),and the DCR in the KRAS G12 C group was 89.5% lower than that in the KRAS non-G12 C group(97.4%),with no statistically significant difference(p>0.05);median PFS in the KRAS G12 C and KRAS non-G12 C groups:8.3 months vs.7.8 months(p=0.483);median OS in the KRAS G12 C and KRAS non-G12 C groups: 20.6 months vs.15.4 months(p=0.176).(p=0.483);median OS in KRAS G12 C group and KRAS non-G12 C group: 20.6 months vs.15.4 months(p=0.176).statistically significant effect of patients with ECOG score 2 relative to patients with score 1 and stage IV patients relative to stage III patients on PFS in patients with KRAS mutation(p<0.05);stage IV patients had a statistically significant effect on OS relative to stage III patients(p<0.05).The ORR in the G12 C mutation-only group was 66.7% higher than that in the G12 C co-mutation group(50.0%),and the DCR in the G12 C mutation-only group was 89.5% lower than that in the G12 C co-mutation group(91.7%),with no statistically significant difference(p>0.05).Median PFS in the G12 C mutation-only and G12 C co-mutation groups: 9.0 months vs.8.1 months(p=0.025).Median OS in the G12 C mutation alone and G12 C co-mutation groups: 21.3 months vs.20.3months(p=0.666).the effect on PFS in patients with KRAS G12 C mutation was statistically significant in stage IV patients compared to stage III patients(p<0.05).Conclusion:There was no significant difference in ORR,DCR,PFS and OS between KRAS G12 C group and KRAS non-G12 C group.There was no significant difference in ORR,DCR,and OS between the G12 C mutation group and the G12 C co-mutation group,but the G12 C mutation group had longer PFS.The G12 C mutation alone may be a better predictor of first-line treatment benefits for advanced NSCLC patients with KRAS mutation. |
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