The Characteristic Of Organ Metastasis And Survival In Advanced Nsclc Patients With Egfr Mutation

Objective: The present retrospective study was performed to evaluate the survival data and clinicopathological characteristics of advanced NSCLC patients with EGFR mutation,and to investigate the relationship between the characteristic of organ metastasis with survival time,performance status and efficacy of targeted therapy.Methods: The clinicopathological characteristics and survival data of metastasis NSCLC patients who were treated with the first-generation epidermal growth factor receptor-tyrosinekinase inhibitor drug(Icotinib hydrochloride)in the Fourth Hospital of Hebei Medical University between January 2012 and December 2018 were reviewed.The relationship between the characteristic of organ metastasis and overall survival,ECOG scores and efficacy of TKI targeted therapy of patients with advanced NSCLC were analyzed.All the statistical analysis were performed using SPSS 23.0 statistical software.The Kaplan-Meier method was used to assess survival curves and the log-rank test was used in the univariate analysis.The multivariate survival analysis were performed using the Cox proportional hazards model to investigate the effects of clinicopathological factors on survival.The Logistic regression analysis were performed to analyzed the effects of organ metastasis on ECOG score and targeted therapy.The statistically significant difference was determined as P<0.05.Results: A total of 258 NSCLC patients with EGFR mutation were enrolled in this study,including 146 cases of females(56.6%),241 cases of adenocarcinomas(93.4%)and 212 cases of non-smokers(82.2%).Among these patients,111(43.0%),107(41.5%),87(33.7%),65(25.2%),65(25.2%),22(8.5%),11(4.3%)cases had bone,lung,pleural,brain,extrathoracic lymph node,liver,adrenal metastases,respectively.Median overall survival(m OS)was 32.9 months(95% CI: 29.8-36.0).The 1-,2-,3-,4 and 5-year survival rates of NSCLC patients with EGFR mutations were 87.6,67.8,42.0,33.0 and 20.2%,respectively.In a multivariate analysis using the Cox proportional hazards model,liver(HR 2.00,95% CI: 1.16-3.46,P=0.012),bone(HR 1.73,95% CI: 1.24-2.43,P=0.001),extrathoracic lymph node(HR 1.67,95% CI: 1.16-2.42,P=0.006)and pleural metastases(HR 1.62,95% CI: 1.14-2.30,P=0.008)were unfavorable prognostic factors,and the presence of metastases to the abdomen(HR 1.87,95% CI: 1.21-2.90,P=0.005)and the extremities(HR 1.68,95% CI: 1.20-2.34,P=0.002)were associated with a poorer survival.Using logistic regression analysis,the pleural(HR 6.04,95 % CI: 3.02-12.10,P=0.000),liver(HR 3.26,95% CI: 1.11-9.58,P=0.032),bone(HR 2.51,95% CI: 1.34-4.72,P=0.004),lung(HR 2.09,95% CI: 1.14-3.83,P=0.017),brain(HR 2.06,95% CI: 1.04-4.10,P=0.039)and extrathoracic lymph node metastases(HR 4.65,95% CI: 2.24-9.64,P=0.000)were associated with poor ECOG scores(PS ? 2).As regards metastatic location,the presence of abdominal metastases(HR 5.07,95% CI: 2.16-11.87,P=0.000),thoracic metastases(HR 2.62,95% CI: 1.45-4.73,P= 0.001)and extremity metastases(HR 1.76,95% CI: 1.01-3.06,P= 0.046)were correlated with a poor ECOG scores(PS ? 2).The liver(HR 2.81,95% CI: 1.08-7.30,P=0.033),bone(HR 2.18,95% CI: 1.21-3.92,P=0.009)and extrathoracic lymph node metastases(HR 3.98,95% CI: 2.09-7.60,P=0.000)was found to be associated with the poor response of TKI treatment,and abdominal organ metastasis(HR 2.22,95% CI: 1.09-4.54,P=0.029)and extremities metastases(HR 2.01,95% CI: 1.14-3.54,P=0.016)were correlated with the poor efficacy of TKI.Conclusions:1.The first-generation EGFR-TKI drug(icotinib hydrochloride)was effective in treating advanced NSCLC patients with EGFR mutation.Liver,bone,extrathoracic lymph node and pleural metastases were unfavorable independent prognostic factors,and the abdomen and extremities metastases were independent prognostic factors for overall survival of NSCLC patients with EGFR mutation.2.Patients with metastases to the pleural,liver,bone,lung,brain and extrathoracic lymph node were correlated with a poor ECOG scores,and the presence of metastases to the abdomen,thorax,and the extremities were correlated with a poor ECOG scores.3.The presence of metastases to the liver,bone and extrathoracic lymph node was found to be associated with the poor response of EGFR-TKI treatment,and abdominal metastases and extremities metastases were correlated with the poor efficacy of EGFR-TKI.