Factors associated with the prognosis and long-term survival of patients with metastatic lung adenocarcinoma: a retrospective analysis

Abstract

Background: Outcome of patients with advanced non-small cell lung cancer (NSCLC) treated with platinum-based doublet chemotherapy is usually poor, with overall survival ranges from 8-13 months.However, the overall survival is improved to 21-28 months in the era of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI). This study aimed to explore the prognostic factors to predict longterm survival in the era of EGFR TKI. Methods: A total 1,030 patients were studied who had been diagnosed with metastatic adenocarcinoma of lung from January 2005 to December 2009 at Linkou Chang Gung Memorial Hospital. Long-term survivors (LTS) were defined as patients who survived five years or more after the initial diagnosis of stage IV disease.Data on patient age, gender, smoking status, performance status at diagnosis, TNM stage, metastatic pattern, number of metastases, and organs with tumor involvement, EGFR gene mutation status, types of treatment received, EGFR TKI treatment and longest EGFR TKI duration were retrospectively obtained from medical charts. We calculated the odds ratio (OR) of long-term survival from collected clinical parameters to predict long-term survival. Results: In this large retrospective study, we reported a five-year survival of 5.0% among patients with metastatic adenocarcinoma of lung. A total 52 LTS and 978 non-LTS were identified. Patients had more contralateral or pleural/pericardial metastases in the LTS group than in the non-LTS group (51.9% vs.19.0%, P<0.001), while less extrathoracic spread than in the non-LTS group (42.3% vs. 79.6%, P<0.001).The mutation of the EGFR gene was more frequent in the LTS group than in the non-LTS group (19.2% vs. 7.1%, P=0.006). Conclusions:In conclusion, our results suggest that an age younger than 60 years, absence of extrathoracic spread and EGFR TKI treatment duration of more than one year play an important role in the long-term for survivors who survive for more than 5 years.

Post‐progression survival is highly linked to overall survival in patients with non‐small‐cell lung cancer harboring sensitiveEGFRmutations treated with first‐line epidermal growth factor receptor‐tyrosine kinase inhibitors

“…38 Similarly, Huang et al reported that EGFR-TKI treatment duration of more than one year plays an important role in long-term survival. 39 Our study has several limitations. First, the sample size was relatively small.…”

“…Similarly, Huang et al . reported that EGFR‐TKI treatment duration of more than one year plays an important role in long‐term survival …”

Long Term Survival in Patients with Metastatic Adenocarcinoma of the Lung in the Era of Targeted Agents

“…The results of our retrospective study did not provide a definitive answer to the question whether erlotinib increases LTS in patients with EGFR-mutated MAL. Recently the results of a large retrospective Chinese study suggested that an age younger than 60, absence of extrathoracic spread and EGFR TKI treatment duration of more than one year may play an important role in survival beyond five years (18).…”

Local Ablative Therapies in Oligometastatic NSCLC: New Data and New Directions

“…25 Gains in survival due to improved systemic therapy (with the introduction of targeted agents and immune checkpoint inhibitors [ICIs]) have further inspired research into the oligometastatic paradigm, with the hypothesis that local therapy has greater benefit with improved control of micrometastatic disease. [26][27][28][29] Improvements in systemic therapy have also led to another novel application for ablative therapies: to eradicate areas of oligoprogression. Despite high initial response rates to targeted therapy with tyrosine kinase inhibitors (TKIs) and ICIs, acquired resistance remains a challenge, with a median PFS of approximately 10 months in patients treated with TKIs or pembrolizumab as first-line therapy.…”