Yusuke Okuma1,2, Jumpei Kashima3, Kageaki Watanabe4, Sadamu Homma5. 1. Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan. y-okuma@cick.jp. 2. Division of Oncology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan. y-okuma@cick.jp. 3. Department of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan. 4. Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan. 5. Division of Oncology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan.
Abstract
PURPOSE: Metastasis of non-small cell lung cancer (NSCLC), indicating hematogenous dissemination, is more frequent in patients harboring epidermal growth factor receptor (EGFR) mutations, who respond dramatically to EGFR-tyrosine kinase inhibitors (TKIs). METHODS: Based on the proposed association of miliary pulmonary metastasis and EGFR mutations in the previous studies, we conducted a retrospective study to assess survival of NSCLC with miliary pulmonary metastases in 223 patients harboring EGFR mutations who were treated with single agent EGFR-TKIs. RESULTS: Progression-free survival (PFS) and overall survival (OS) with single agent EGFR-TKIs were 11.7 months [95% confidence interval (CI) 9.6-13.7] and 23.7 months (95% CI 20.3-26.9), respectively. Patients with and without miliary pulmonary metastases were matched using propensity scores (n = 29 per group) based on clinical characteristics. After matching, the PFS were 8.2 months (95% CI 5.2-15.0) and 14.3 months (95% CI 9.6-30.0) (p = 0.02) in patients with and without miliary pulmonary metastases, respectively. Conversely, the OS were 15.3 months (95% CI 10.6-19.4) and 27.9 months (95% CI 22.0-33.0) (p = 0.003) in patients with and without miliary pulmonary metastases, respectively. By multivariate analysis, miliary pulmonary metastasis was associated with poor prognosis (p = 0.0035). CONCLUSION: The prognosis of patients with advanced NSCLC harboring EGFR mutations with miliary pulmonary metastasis demonstrated significantly worse outcomes compared to those without miliary pulmonary metastasis.
PURPOSE: Metastasis of non-small cell lung cancer (NSCLC), indicating hematogenous dissemination, is more frequent in patients harboring epidermal growth factor receptor (EGFR) mutations, who respond dramatically to EGFR-tyrosine kinase inhibitors (TKIs). METHODS: Based on the proposed association of miliary pulmonary metastasis and EGFR mutations in the previous studies, we conducted a retrospective study to assess survival of NSCLC with miliary pulmonary metastases in 223 patients harboring EGFR mutations who were treated with single agent EGFR-TKIs. RESULTS: Progression-free survival (PFS) and overall survival (OS) with single agent EGFR-TKIs were 11.7 months [95% confidence interval (CI) 9.6-13.7] and 23.7 months (95% CI 20.3-26.9), respectively. Patients with and without miliary pulmonary metastases were matched using propensity scores (n = 29 per group) based on clinical characteristics. After matching, the PFS were 8.2 months (95% CI 5.2-15.0) and 14.3 months (95% CI 9.6-30.0) (p = 0.02) in patients with and without miliary pulmonary metastases, respectively. Conversely, the OS were 15.3 months (95% CI 10.6-19.4) and 27.9 months (95% CI 22.0-33.0) (p = 0.003) in patients with and without miliary pulmonary metastases, respectively. By multivariate analysis, miliary pulmonary metastasis was associated with poor prognosis (p = 0.0035). CONCLUSION: The prognosis of patients with advanced NSCLC harboring EGFR mutations with miliary pulmonary metastasis demonstrated significantly worse outcomes compared to those without miliary pulmonary metastasis.
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Authors: Edward S Kim; Vera Hirsh; Tony Mok; Mark A Socinski; Radj Gervais; Yi-Long Wu; Long-Yun Li; Claire L Watkins; Mark V Sellers; Elizabeth S Lowe; Yan Sun; Mei-Lin Liao; Kell Osterlind; Martin Reck; Alison A Armour; Frances A Shepherd; Scott M Lippman; Jean-Yves Douillard Journal: Lancet Date: 2008-11-22 Impact factor: 79.321