| Objective: To retrospectively analyze the advanced non-small cell lung cancer with known EGFR mutation status in clinical and pathological features,biomakers,clinical staging and treatment strategy,to explore the related prognosis factors of advanced NSCLC?Methodology:1.Research object:132 NSCLC with known EGFR status,evaluable lesions and no second primary tumor,who is newly diagnosed or post-operative relapse during January 2014-December 2015 in Liaoning Cancer Hospital.2.Information collection: sex,age,smoking history,family history of cancer,association with diabetes,hypertension,PS score,EGFR mutation status,pathologic type,lymph node and distant metastasis,tumor markers such as pre-treatment cytokeratin 19 fragment antigen(CYFRA21-1),serum carcinoembryonic antigen(CEA),peripheral blood neutrophil count,lymphocyte count,monocyte count and treatment measure.3.SPSS 23.0 software is used for statistical analysis.Chi-square test was used in correlation analysis among the variables.Kaplan-Meier method was used for survival analysis,and Log rank test was carried out,and Cox risk regression model was used to analyze the prognostic factors of the selected prognostic factors.The cut-off value of NLR and LMR was calculated by working curve(ROC curve)in 127 patients with the complete data of neutrophil,lymphocyte and monocyte,and the median PFS node was calculated.P<0.05 was statistically significant.Results:1.This study collected 79(58.5%)males from 132 NSCLC patients,also including 53 women(40.15%),27 aged over 65(20.45%),and?65 years 105(79.55%).There were 43 smokers(32.6%),and 7(5.30%),12(9.09%)and 13(9.85%)cases with family history of diabetes,hypertension and tumor at first visit.22 patients(16.67%)with KPS score of ?70,59 cases(44.7%)out of 80,51 cases(38.64%)were greater than or equal to 90.2.Pathology:119 cases of adenocarcinoma(90.15%),squamous cell carcinoma in 5 cases(3.8%),adenosquamous carcinoma in 3 cases(2.3%),and non-small cell lung cancer in 4 cases(3.0 %),adenoid cystic carcinoma occurred in 1 case(0.7 %).3.EGFR status:66(50.0%)EGFR wild-type patients and 66(50.0%)EGFR mutations were found.74(56.06%)patients finished EGFR detecting before treatment beginning,58(43.94%)finished later.EGFR mutations are more common in non-smoking patients.4.Staging :10 cases(7.58%)were inoperable stage IIIa,17 cases(12.88 %)in IIIb stage and 105 cases in stage IV(79.55%).27 cases had no distant metastasis(20.45%),39 cases(29.55%)were confined to the thoracic cavity,and 66 cases(50 %)were over the thoracic cavity.5.Peripheral blood serum CEA was normal in 42 cases(35.59 %),76 cases(64.41 %)higher than normal,and CYFRA21-1 was normal(normal value was 0-3.3)in 42 cases for example,76 cases were above normal value(64.41%).The cut-off values of NLR and LMR calculated by ROC curves were 3.69 and 5.01,respectively.LMR 5.01 was more common in men(P<0.001),smokers(P = 0.039),tumor size>3.5 cm(P = 0.005),and patients without bone metastasis(P=0.020).6.Treatment stradegy: among all patients,74 patients(56.06%)completed EGFR gene detection at first visit.Forty-four patients(31.82%)received EGFR-TKIs,of which 42(95.45%)had EGFR mutations and 2(1.59%)had EGFR wild type.Among 88 patients receiving chemotherapy,64(72.73%)were EGFR wild type,EGFR mutation occurred in 24 cases(27.27%).Of the 66 EGFR mutations,42(31.81%)received first-line EGFR-TKIs,and 24(18.18%)received first-line chemotherapy.Of the 66 EGFR wild-type patients,2(3.03 %)received first-line EGFR-TKIs and 64(96.97%)received first-line chemotherapy.Thirty-five patients(26.52%)received radiotherapy during first-line chemotherapy,and 97(74.48%)received chemotherapy alone or EGFR-TKIs,and did not receive radiotherapy.Thirty patients did not receive second-line treatment and 102 received second-line treatment.Among them,57 cases(55.89%)received second-line chemotherapy only,and 39 cases(38.24%)only received EGFR-TKIs,and 6 cases(1.69%)were treated with chemotherapy combined with other drugs.Only 68 patients(51.52%)received chemotherapy and 28(21.21%)received EGFRTKIs,41(31.06%)received chemotherapy as well as EGFR-TKIs.7.Follow-up: As of January 31,2018,59(44.7%)of the 132 patients died,the median OS23.73 months.8.Survival analysis: Kaplan-Meier univariate analysis showed that the median PFS of first-line patients receiving EGFR-TKIs was 11.8 months,and the median PFS of firstline patients receiving chemotherapy was 7.0 months(P<0.05);the median PFS was 7.1 months in patients with only EGFR-TKIs or chemotherapy without radiotherapy,and the median PFS was 11.47 months(P<0.05).The second-line median PFS of adenocarcinoma patients was 1.83 months(5.53months)longer than that of non-adenocarcinoma patients Vs At 3.7 months(P<0.05),the median PFS of EGFR mutant NSCLC was 7.77 months,3.7 months longer than that of wild-type patients(P<0.05).The median PFS was 4.47 months for chemotherapy,5.73 months for chemotherapy combined with other treatments,and 9.47 months for EGFR-TKIs alone(P<0.05).For patients with EGFR mutation,OS was 50.57 months,and only 25.6 months in wild type patients(P<0.05).The OS of NLR 3.69 patients was 47.73 months,and the OS of NLR>3.69 group was 22.97 months(P<0.05).The OS of patients receiving EGFR-TKIs was 48.35 months,and the OS was 53.40 months after receiving chemotherapy and EGFR-TKIs.Cox multi-factor analysis showed that the first-line treatment was the independent factors of first-line PFS,and EGFR mutation state was the independent influence factor of second-line PFS.EGFR mutation state,NLR and EGFR-TKIs were independent influencing factors of OS.Conclusion:1.56.06% of patients completed EGFR gene mutation detection before first-line treatment,the others finished later.2.In advanced NSCLC with known EGFR gene status,EGFR gene mutation had better prognosis.EGFR mutation and NLR before treatment were independent prognostic factors for advanced NSCLC.The sensitivity of serum CEA and CYFRA21-1 levels was low,and they were not independent prognostic factors.3.Advanced NSCLC with EGFR-mutation receiving EGFR-TKIs can significantly prolong PFS and OS. |
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