Clinical Outcomes Of Surgery Combined With Targeted Therapy In Non-Small Cell Lung Cancer

Lung cancer is currently one of the most common cancers,accounting for the leading cause of cancer mortality in China,of which 80% is non-small cell lung cancer(NSCLC).Surgery is the most complete and effective way to treat NSCLC,especially early-stage NSCLC.Therefore,it is critical to undergo timely and effective surgical treatment for patients with NSCLC.To improve patients' prognosis,most NSCLC patients need adjuvant chemotherapy after operation.However,chemotherapy has some side effects,resulting in poor compliance,and the recurrence rate of tumor after chemotherapy is still as high as 70%.With the development of precision medicine and high throughput sequencing technology,targeted therapy for lung cancer has been developing rapidly.Among them,epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)is the most widely used and effective treatment in NSCLC.Nowadays,the effect of operation combined with EGFR-TKI in the treatment of adenosquamous carcinoma of the lung(ASC)is not clear.In this study,27 cases of ASC patients with positive mutation of EGFR who were treated with TKI were retrospectively analyzed.Of these patients,9 patients achieved partial response,11 patients achieved stable disease,and the disease control rate reached 74.1%(20/27).The median overall survival time was 39 months(95%CI: 25.6-52.4),the median progression-free survival time was 15 months(95%CI: 12.9-17.1),and the median survival time after relapse was 19 months(95%CI: 0.9-37.1).The 3-and 5-year survival rate postoperatively was 51.9% and 15.3%,respectively.Therefore,the ASC patients with EGFR mutation responded well to the operation combined with TKI.For ASC patients,routine detection of EGFR mutations is recommended.In addition,the efficacy of surgical treatment in advanced NSCLC patients with pleural dissemination(PD)are still controversial.Due to the poor prognosis of patients with advanced NSCLC,it has been considered as a contraindication for surgery.But PD is sometimes found during operation unexpectedly.We summarized and analyzed the data of 168 NSCLC patients who were accidentally found malignant PD intraoperatively.The median progression-free survival(mPFS)and median overall survival(mOS)were respectively 13 months and 41 months.The 3-and 5-year PFS and OS rates for all patients were 13.1%,5.7% and 56.0%,28.7%,respectively.The patients were divided into two groups according to whether the patients underwent primary tumor resection or not.Seventy-four(42.3%)patients received biopsy alone,and 94(57.7%)received primary tumor resection.In comparison,patients in the resection group had better mPFS(19.0 months vs.10.0 months,P<0.001)and mOS(48.0 months vs.33.0 months,P<0.001)than those in the biopsy group significantly.The 3-and 5-year PFS rates of resection group were higher than biopsy group(20.8% and 10.8% vs.3.2% and 0).Similar results were seen for OS(67.8% and 37.7% vs.41.0% and 18.2%).NSCLC patients with malignant pleural dissemination diagnosed intraoperatively may be beneficial from surgical resection of main tumor and multidisciplinary adjuvant therapy,especially targeted therapy.