Real-World Survival Outcomes Based on EGFR Mutation Status in Chinese Patients With Lung Adenocarcinoma After Complete Resection: Results From the ICAN Study

Xue-Ning Yang; Hong-Hong Yan; Jun Wang; Xiang-Yang Chu; Zhi-Dong Liu; Yi Shen; Hai-Tao Ma; Xiang-Ning Fu; Jian Hu; Nai-Kang Zhou; Yong-Yu Liu; Xin-Ming Zhou; Jing-Song Li; Kang Yang; Jian Li; Lin Xu; Si-Yu Wang; Qun Wang; Lun-Xu Liu; Shun Xu; Zhong-Yuan Chen; Hong-He Lou; Chang-Li Wang; Ying Cheng; Si-Yang Liu; Xu-Chao Zhang; Wen-Zhao Zhong; Yi-Long Wu

doi:10.1016/j.jtocrr.2021.100257

Real-World Survival Outcomes Based on EGFR Mutation Status in Chinese Patients With Lung Adenocarcinoma After Complete Resection: Results From the ICAN Study

JTO Clin Res Rep. 2021 Nov 25;3(1):100257. doi: 10.1016/j.jtocrr.2021.100257. eCollection 2022 Jan.

Authors

Xue-Ning Yang¹, Hong-Hong Yan¹, Jun Wang², Xiang-Yang Chu³, Zhi-Dong Liu⁴, Yi Shen⁵, Hai-Tao Ma⁶, Xiang-Ning Fu⁷, Jian Hu⁸, Nai-Kang Zhou⁹, Yong-Yu Liu¹⁰, Xin-Ming Zhou¹¹, Jing-Song Li¹², Kang Yang¹³, Jian Li¹⁴, Lin Xu¹⁵, Si-Yu Wang¹⁶, Qun Wang¹⁷, Lun-Xu Liu¹⁸, Shun Xu¹⁹, Zhong-Yuan Chen²⁰, Hong-He Lou²¹, Chang-Li Wang²², Ying Cheng²³, Si-Yang Liu¹, Xu-Chao Zhang¹, Wen-Zhao Zhong¹, Yi-Long Wu¹

Affiliations

¹ Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
² Thoracic Surgery Department, Peking University People's Hospital, Beijing, People's Republic of China.
³ Thoracic Surgery Department, 301 Hospital, Beijing, People's Republic of China.
⁴ Thoracic Surgery Department II, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China.
⁵ Thoracic Surgery Department, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, People's Republic of China.
⁶ Thoracic Surgery Department, the First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
⁷ Thoracic Surgery Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
⁸ Thoracic Surgery Department, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China.
⁹ Thoracic Surgery Department, 309 Hospital, Beijing, People's Republic of China.
¹⁰ Thoracic Surgery Department, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China.
¹¹ Thoracic Surgery Department, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
¹² Thoracic Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
¹³ Thoracic Surgery Department, The First Affiliated Hospital of Third Military Medical University, Chongqing, People's Republic of China.
¹⁴ Thoracic Surgery Department, Peking University First Hospital, Beijing, People's Republic of China.
¹⁵ Thoracic Surgery Department, Jiangsu Cancer Hospital, Nanjing, People's Republic of China.
¹⁶ Thoracic Surgery Department, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.
¹⁷ Thoracic Surgery Department, Zhongshan Hospital Fudan University, Shanghai, People's Republic of China.
¹⁸ Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
¹⁹ Thoracic Surgery Department, The First Hospital of China Medical University, Shenyang, People's Republic of China.
²⁰ Thoracic Surgery Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
²¹ Thoracic Surgery Department, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
²² Lung Cancer Center, Tianjin Medical University Cancer Institute & Hospital, Tianjin, People's Republic of China.
²³ Medical Oncology, Jilin Cancer Hospital, Changchun, People's Republic of China.

Abstract

Introduction: The adjuvant treatment of patients with resected lung adenocarcinoma (LUAD) remains unstandardized. We analyzed the survival outcomes of these patients based on EGFR mutation status and adjuvant chemotherapy treatment.

Methods: This noninterventional real-world study (ICAN) enrolled Chinese patients with resected stages I to III LUAD from April 8, 2010, to December 31, 2010. Tumor EGFR mutation status and 3-year disease-free survival (DFS) were determined. The extension phase provided long-term follow-up with overall survival (OS) as the primary end point. Secondary end points included DFS and prognostic factors of survival. Survival outcomes based on adjuvant chemotherapy treatment, EGFR mutation status, and postoperative stage were analyzed post hoc.

Results: Among 568 patients in the ICAN cohort, 472 continued to the extension phase and remained eligible. The 3-year DFS rate was 58.8%. In the extension cohort, 260 patients (55.1%) had EGFR-mutant disease and 207 (43.9%) received adjuvant chemotherapy. At a median follow-up of 109.0 (95% confidence interval [CI]: 106.6-111.4) months, median OS and DFS were 103.3 (95% CI: 101.7-104.9) and 67.4 (95% CI: 49.7-85.2) months, respectively. The 5-year OS and DFS rates were 68.9% (95% CI: 64.3-73.6) and 52.9% (95% CI: 48.2-57.7), respectively. EGFR wild-type disease was a significant independent predictor of worse OS (HR = 1.24, 95% CI: 1.07-1.44, p= 0.004) based on the Cox regression analysis of common factors. Post hoc subgroup analysis revealed that survival outcomes were not significantly different with adjuvant chemotherapy regardless of EGFR mutation status across all postoperative stages.

Conclusions: EGFR mutations are common in operable LUAD, and recurrence and mortality after resection were considerable. Adjuvant chemotherapy did not improve survival outcomes, regardless of EGFR mutation status and postoperative stage.

Keywords: Adjuvant chemotherapy; EGFR mutation; Lung adenocarcinoma; Prognostic factors; Surgical resection.