Prognostic Factors Of Advanced NSCLC Patients With Rare EGFR Mutations

Objective:NSCLC is the most common pathological type of lung cancer,EGFR is the most common mutant gene type of NSCLC.EGFR-TKIs have been proved to have significant advantages in the efficacy and prognosis of EGFR-sensitive mutations in a number of large global clinical controlled studies and the real world.However,there are few studies on the prognostic factors of rare EGFR mutations.This study will explore the prognostic factors of advanced NSCLC patients with rare EGFR mutations from pre-treatment clinical characteristics,peripheral blood laboratory tests,inflammatory composite indicators,and first-line treatment methods.Methods:Selects the tumor hospital of Shanxi Province from January 1,2016 to 31 December 2018 136 cases diagnosed by histopathological and molecular laboratory examination of EGFR rare mutations advanced NSCLC patients as the research object,36 patients due to reasons such as incomplete data out,eventually collected the clinical data of 100 patients,Including gender,age,BMI,smoking degree,PS score,clinical TNM stage,pathological and molecular type,first-line therapy(targeted therapy,chemotherapy),CEA,LDH,D-dimer,NLR,PLR,SII,and patients were followed up until December 31,2021.PFS and OS of patients were recorded.Using ROC curve to determine the SII before treatment,NLR,the best cutoff value of PLR using Kaplan Meier-survival curve drawing method,use log-rank test for the prognosis of single factor analysis,the single factor in the survival analysis was statistically significant variables,using COX proportional hazards models for multi-factor survival analysis,Looking for independent prognostic factors for PFS and OS.P < 0.05 was statistically significant.Results:1.Log-rank single factor test analysis results:All patients had a median OS of 543 days and a median PFS of 201 days.(1)There were 50 patients in the chemotherapy group and 50 patients in the targeted group,taking OS as the observation target.P=0.75,taking PFS as the observation target,P=0.001.(2)There were 51 cases in female group and 49 cases in male group,taking OS as the observation target,P=0.124,taking PFS as the observation target,P=0.077.(3)A total of 61 patients were aged < 65 years,and 39 patients were aged≥65 years,taking OS as the observation target,P=0.425,taking PFS as the observation target,P=0.121.(4)There were 62 cases in non-heavy smoking group and 38 cases in heavy smoking group,taking OS as the observation target,P=0.053,taking PFS as the observation target,P=0.094.(5)PS score 0-1 group a total of 95 cases,PS score 2 group a total of 5 cases,taking OS as the observation target,P=0.262,taking PFS as the observation target,P=0.418.(7)There were 8 cases in the non-adenocarcinoma group and 92 cases in the adenocarcinoma group,taking OS as the observation target,P=0.111,taking PFS as the observation target,P=0.565.(8)There were 77 cases in CEA < 50ug/L(3+)group and 23 cases in CEA≥50ug/L(3+)group,taking OS as the observation target,P=0.006,taking PFS as the observation target,P=0.528.(8)There were66 cases in LDH≤248U/L group and 34 cases in LDH>248U/L group,taking OS as the observation target,P=0.100,taking PFS as the observation target,P=0.194.(9)There were22 cases in D-dimer ≤200ng/m L group and 78 cases in D-dimer > 200ng/m L group,taking OS as the observation target,P=0.089,taking PFS as the observation target,P=0.275.(10)There were 45 cases in TNM stage < Ⅳb group and 55 cases in TNM stage for Ⅳb group,taking OS as the observation target,P=0.018,taking PFS as the observation target,P=0.686.(11)There were 54 cases in healthy weight group and 46 cases in non-healthy weight group,taking OS as the observation target,P=0.862,taking PFS as the observation target,P=0.255.Taking OS as the observation target,the optimal truncation values of inflammatory composite indexes before treatment were 787.595 for SII,2.341 for NLR,and 173.323 for PLR.There were 48 cases in SII < 787.595 group and 52 cases in SII≥787.595 group,P=0.007.34 patients in the NLR < 2.341 group and 66 patients in the NLR≥2.341 group,P=0.016.There were 53 cases in PLR < 173.323 group and 47 cases in PLR≥173.323group(P=0.638).With PFS as the observation target,the area under the inflammatory composite index curve before treatment was all < 0.5,indicating no diagnostic value.Therefore,no statistical analysis was conducted on the influence of inflammatory composite index before treatment on PFS.2.Using COX proportional hazards models for multi-factor survival analysis results:CEA(RR: 2.203,95%CI: 1.203-4.036,P=0.011),TNM staging(RR: 1.728,95%CI: 1.055-2.829,P=0.030)was an independent risk factor for OS in advanced NSCLC patients with rare EGFR mutations.Conclusion:1.TNM stage,CEA,SII and NLR were correlated with OS in advanced NSCLC patients with rare EGFR mutations.2.First-line therapy is associated with PFS in advanced NSCLC patients with rare EGFR mutations.3.CEA and TNM stage are independent prognostic factors for OS in advanced NSCLC patients with rare EGFR mutations.