Detected EGFR Mutation Could Predict Better Outcome of Lung Adenosquamous Carcinoma Patients

偵測上皮細胞生長因素接收器突變可能可用以預測肺部腺鱗癌病患有較佳的預後

張育平(Yu-Ping Chang) ； 張晃智(Huang-Chih Chang) ； 方文豐(Wen-Feng Fang) ； 王金洲(Chin-Chou Wang) ； 黃國棟(Kuo-Tung Huang) ； 陳友木(Yu-Mu Chen) ； 林炯佑(Chiung-Yu Lin) ； 林孟志(Meng-Chih Lin)

《胸腔醫學》 31卷2期 (2016/04) Pp. 77-87

摘要

前言：上皮細胞生長因素接收器突變的肺腺癌有較佳的預後，但是其在肺部腺鱗癌的角色仍然在研究中，我們的目標是評估此突變對於晚期的肺部腺鱗癌預後的影響。方法：回溯性收集2004年至2013年於高雄長庚醫院診斷肺部腺鱗癌的74位病人的資料，並且收集2011年7月至2012年六月診斷為IIIB或第四期的肺腺癌及鱗狀細胞癌病人共260位的資料以比較無惡化存活期及整體存活期。結果：17位肺部腺鱗癌病人接受分析，其中8位無突變，9位有突變。有突變這組有較多的未抽菸者（9/9, 100%, p=0.029）。肺腺癌於第一線的治療有較佳的無惡化存活期，其次為腺鱗癌及鱗狀細胞癌。有突變的腺鱗癌相較於沒有突變的腺鱗癌有較佳的無惡化存活期。結論：我們發現腺鱗癌的預後介於肺腺癌及鱗狀細胞癌之間。而且，上皮細胞生長因素接收器突變的腺鱗癌相較於沒有突變的腺鱗癌似乎有較佳的預後。因此為了增進病人的存活率，對於腺鱗癌的病人應該要檢測此突變，特別是未曾抽菸者。

關鍵字

上皮細胞生長因素接收器突變 ； 肺部腺鱗癌 ； 預後

並列摘要

Introduction: Epidermal growth factor receptor (EGFR)-mutant adenocarcinomas (ADC) have a better prognosis than EGFR-wild type cancers, but the role of EGFR in adenosquamous carcinoma (ADSC) is still under investigation. Our aim in this study was to evaluate the role of EGFR mutation in the prognostic outcome of advanced ADSC. Methods: We retrospectively reviewed the medical records of 74 patients diagnosed with ADSC from January 2004 to December 2013, and collected data on 260 patients diagnosed with stage IIIB/IV ADC and squamous cell carcinoma (SCC) from July 2011 to June 2012 to further compare progression-free survival (PFS) and overall survival (OS). Results: Seventeen (17/74, 23.0%) ADSC patients underwent EGFR mutation analysis; 8 (47.1%) were wild-type, and 9 (52.9%) were EGFR-mutant. More never-smokers were found in the EGFR-mutant group (9/9, 100%, p=0.029). ADC patients had significantly better PFS with first-line treatment, followed by ADSC and SCC patients (median PFS: 4.39, 3.50, 2.86 months, respectively; log-rank=0.002). There was no significant difference in OS between the ADC, SCC, and ADSC groups. The ADSC EGFR-mutant group had significantly better PFS than the wild-type group (3.75 vs. 0.71 months; log-rank=0.010), but there was no statistical difference in OS between the 2 groups. Conclusion: We found that the prognosis of the ADSC patients was midway between that of the SCC and ADC patients. Furthermore, EGFR-mutant ADSC patients tended to have a better prognosis than those with wild-type ADSC. Our results suggest that to improve ADSC patient survival, we should check for EGFR mutation, especially in never-smokers.

並列關鍵字

EGFR (epidermal growth factor receptor) mutation ； lung adenosquamous carcinoma ； outcome