Clinical features and related factors for treatment of non-small cell lung cancer patients with long-term survival_West China Medical Journal

Authors：

QIN Yi ,  HUANG Meijuan , LI Yanying , YU Min , LIU Lan , REN Li , WANG Yongsheng , GONG Youling , PENG Feng , ZHU Jiang , DING Zhenyu , LIU Yongmei , XU Yong , WANG Jin , ZHOU Xiaojuan , LU You

Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

HUANG Meijuan, Email: hmj107@163.com

Keywords：

Long-term survival; Five-year survival rate; Non-small cell lung cancer; Stage Ⅳ; Prognosis

DOI：

10.7507/1002-0179.201812075

Video：

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Objective To investigate the clinical features of non-small cell lung cancer (NSCLC) patients with long-term survival and the related factors for treatment. Methods A retrospective analysis of clinical features, treatment factors, and survival was performed for 963 patients with pathologically confirmed stage Ⅳ NSCLC between January 2010 and December 2015 from Department of Thoracic Oncology, West China Hospital, Sichuan University. Results The median overall survival (OS) of the 963 patients was 20.8 months, and the 1-, 3-, 5-, and 7-year survival rates were 72.0%, 21.4%, 15.2%, and 4.8%, respectively. There were 81 patients in the long-term survival group (OS>60 months) and 882 in the non-long-term survival group (OS<60 months). Previous surgery, thoracic radiotherapy and epidermal growth factor receptor (EGFR) gene positive significantly increased the 5-year actual survival rate, reducing the risk of death by 62.0%, 58.8%, and 58.1%, respectively. Compared with the non-long-term survival group, more patients in the long-term survival group received two or more means of treatment including surgery, thoracic radiotherapy, and targeted therapy (28.4% vs. 11.6%, P<0.001) and more patients benefited from fourth- or further-line treatment (24.7%vs. 11.1%, P<0.001). Cox multivariate regression analysis indicated that performance status [hazard ratio (HR)=1.388, 95% confidence interval (CI) (1.199, 1.608), P<0.001] , N stage [HR=1.160, 95%CI (1.058, 1.272), P=0.002] , EGFR gene status [HR=0.588, 95%CI (0.469, 0.738), P<0.001] , previous surgery [HR=0.626, 95%CI (0.471, 0.832), P=0.001] , and thoracic radiotherapy [HR=0.592, 95%CI (0.480, 0.730), P<0.001] were independent prognostic factors of OS. Conclusions Good performance status, early N staging, EGFR mutation, previous surgery, and thoracic radiotherapy are important prognostic factors affecting the survival of advanced NSCLC patients. Long-term survival benefits from combined treatment and effective further-line therapies.

Citation： QIN Yi, HUANG Meijuan, LI Yanying, YU Min, LIU Lan, REN Li, WANG Yongsheng, GONG Youling, PENG Feng, ZHU Jiang, DING Zhenyu, LIU Yongmei, XU Yong, WANG Jin, ZHOU Xiaojuan, LU You. Clinical features and related factors for treatment of non-small cell lung cancer patients with long-term survival. West China Medical Journal, 2019, 34(1): 12-17. doi: 10.7507/1002-0179.201812075 Copy

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12.	Fukuoka M, Wu YL, Thongprasert S, et al. Biomarker analyses and final overall survival results from a phase Ⅲ, randomized, open-label, first-line study of gefitinib versus carboplatin/paclitaxel in clinically selected patients with advanced non-small-cell lung cancer in Asia (IPASS). J Clin Oncol, 2011, 29(21): 2866-2874.
13.	Mitsudomi T, Morita S, Yatabe Y, et al. Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405): an open label, randomised phase 3 trial. Lancet Oncol, 2010, 11(2): 121-128.
14.	Wong DW, Leung EL, So KK, et al. The EML4-ALK fusion gene is involved in various histologic types of lung cancers from nonsmokers with wild-type EGFR and KRAS. Cancer, 2009, 115(8): 1723-1733.
15.	Iyengar P, Kavanagh BD, Wardak Z, et al. Phase Ⅱ trial of stereotactic body radiation therapy combined with erlotinib for patients with limited but progressive metastatic non-small-cell lung cancer. J Clin Oncol, 2014, 32(34): 3824-3830.
16.	王春英, 程明, 汪德文, 等. 吉非替尼聯合同步放療治療 EGFR 突變型轉移性非小細胞肺癌的療效及安全性. 中國腫瘤臨床與康復, 2017(11): 1324-1327.
17.	汪麗, 謝金龍, 吳艷. 吉非替尼靶向介導在 sIMRT 治療非小細胞肺癌中的應用分析. 臨床肺科雜志, 2015, 20(8): 1377-1379, 1384.
18.	Antonia SJ, Villegas A, Daniel D, et al. Durvalumab after chemoradiotherapy in stage Ⅲ non-small-cell lung cancer. N Engl J Med, 2017, 377(20): 1919-1929.
19.	Shaverdian N, Lisberg AE, Bornazyan KA, et al. Previous radiotherapy and the clinical activity and toxicity of pembrolizumab in the treatment of non-small-cell lung cancer: a secondary analysis of the KEYNOTE-001 phase 1 trial. Lancet Oncol, 2017, 18(7): 895-903.

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin, 2009, 59(4): 225-249.
2. 方積乾, 徐勇勇, 陳峰, 等. 衛生統計學. 7版. 北京: 人民衛生出版社, 2012: 419.
3. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37513025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
4. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
5. 史國棟, 徐裕金, 孫曉江, 等. 轉移性非小細胞肺癌患者不同生存期預后分析. 中國現代醫生, 2013, 51(19): 10-12, 51.
6. Ashworth AB, Senan S, Palma DA, et al. An individual patient data metaanalysis of outcomes and prognostic factors after treatment of oligometastatic non-small-cell lung cancer. Clin Lung Cancer, 2014, 15(5): 346-355.
7. de Vin T, Engels B, Gevaert T, et al. Stereotactic radiotherapy for oligometastatic cancer: a prognostic model for survival. Ann Oncol, 2014, 25(2): 467-471.
8. Yang CJ, Gu L, Shah SA, et al. Long-term outcomes of surgical resection for stage Ⅳ non-small-cell lung cancer: a national analysis. Lung Cancer, 2018, 115: 75-83.
9. Collen C, Christian N, Schallier D, et al. Phase Ⅱ study of stereotactic body radiotherapy to primary tumor and metastatic locations in oligometastatic nonsmall-cell lung cancer patients. Ann Oncol, 2014, 25(10): 1954-1959.
10. De Ruysscher D, Wanders R, van BA, et al. Radical treatment of non-small-cell lung cancer patients with synchronous oligometastases: long-term results of a prospective phase Ⅱ trial (Nct01282450). J Thorac Oncol, 2012, 7(10): 1547-1555.
11. Shi Y, Au JS, Thongprasert S, et al. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non-small-cell lung cancer of adenocarcinoma histology (PIONEER). J Thorac Oncol, 2014, 9(2): 154-162.
12. Fukuoka M, Wu YL, Thongprasert S, et al. Biomarker analyses and final overall survival results from a phase Ⅲ, randomized, open-label, first-line study of gefitinib versus carboplatin/paclitaxel in clinically selected patients with advanced non-small-cell lung cancer in Asia (IPASS). J Clin Oncol, 2011, 29(21): 2866-2874.
13. Mitsudomi T, Morita S, Yatabe Y, et al. Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405): an open label, randomised phase 3 trial. Lancet Oncol, 2010, 11(2): 121-128.
14. Wong DW, Leung EL, So KK, et al. The EML4-ALK fusion gene is involved in various histologic types of lung cancers from nonsmokers with wild-type EGFR and KRAS. Cancer, 2009, 115(8): 1723-1733.
15. Iyengar P, Kavanagh BD, Wardak Z, et al. Phase Ⅱ trial of stereotactic body radiation therapy combined with erlotinib for patients with limited but progressive metastatic non-small-cell lung cancer. J Clin Oncol, 2014, 32(34): 3824-3830.
16. 王春英, 程明, 汪德文, 等. 吉非替尼聯合同步放療治療 EGFR 突變型轉移性非小細胞肺癌的療效及安全性. 中國腫瘤臨床與康復, 2017(11): 1324-1327.
17. 汪麗, 謝金龍, 吳艷. 吉非替尼靶向介導在 sIMRT 治療非小細胞肺癌中的應用分析. 臨床肺科雜志, 2015, 20(8): 1377-1379, 1384.
18. Antonia SJ, Villegas A, Daniel D, et al. Durvalumab after chemoradiotherapy in stage Ⅲ non-small-cell lung cancer. N Engl J Med, 2017, 377(20): 1919-1929.
19. Shaverdian N, Lisberg AE, Bornazyan KA, et al. Previous radiotherapy and the clinical activity and toxicity of pembrolizumab in the treatment of non-small-cell lung cancer: a secondary analysis of the KEYNOTE-001 phase 1 trial. Lancet Oncol, 2017, 18(7): 895-903.

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