Salvage surgery for non-small cell lung cancer after tyrosine kinase inhibitor treatment

医学 危险系数 内科学 间变性淋巴瘤激酶 围手术期 肺癌 肿瘤科 酪氨酸激酶抑制剂 癌胚抗原 单变量分析 胃肠病学 置信区间 外科 癌症 多元分析 恶性胸腔积液
作者
Yoichi Ohtaki,Kimihiro Shimizu,Hiroyuki Suzuki,Kenji Suzuki,Masahiro Tsuboi,Tetsuya Mitsudomi,Motoshi Takao,Tomohiro Murakawa,Hiroyuki Ito,Kenichi Yoshimura,Morihito Okada,Masayuki Chida
出处
期刊:Lung Cancer [Elsevier BV]
卷期号:153: 108-116 被引量:28
标识
DOI:10.1016/j.lungcan.2020.12.037
摘要

Objectives The prognostic impact of surgical intervention for recurrent or residual non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) rearrangement after tyrosine-kinase inhibitor (TKI) treatment remains unclear. We aimed to describe the characteristics and outcomes of patients undergoing salvage surgery in this setting. Methods We retrospectively collected and analyzed nationwide Japanese data on perioperative and postoperative outcomes of patients who underwent salvage surgery after EGFR or ALK-TKI during 2010−2015. The primary endpoint was a 3-year overall survival (OS) rate and secondary endpoints were the rate of adverse events, perioperative mortality rate, 3-year recurrence-free survival (RFS) rate, and median survival time after salvage lung resection. Univariate and multivariate analyses were performed to identify independent prognostic factors of OS and RFS. Results Thirty-six patients were included (EGFR-TKI: 33, ALK-TKI: 3). The 3-year OS and RFS after the surgery were 75.1 % (95 % confidence interval [CI] 55.9–86.9 %) and 22.2 % (95 % CI 8.6–39.7 %), respectively. Of clinicopathological factors, the progression of disease while on TKI and preoperative carcinoembryonic antigen (CEA) levels (≥5 ng/mL) were shown to be worse independent prognosticators of OS (hazard ratio [HR] 9.38, 95 % CI 1.57–55.88, P = .014; HR 4.84, 95 % CI 1.62–14.46, P = .005, respectively). Older age at initial treatment (≥70 years) and advanced pathological T stage (T2-T4) were the worse prognosticators for RFS (HR 12.58, 95 % CI 2.51–62.97, P = .002; HR 3.06, 95 % CI 1.04–9.03, P = .043, respectively). Grade 3 adverse events occurred in 5.6 % (2/36) patients, but no deaths were reported within 90 days after surgery. Conclusion Our study showed that salvage surgery after TKI treatment was safe and feasible and may contribute to prolonged OS time by reducing the local tumor burden.
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