59O - The impact of EGFR mutations on the prognosis of resected non-small cell lung cancer: A meta-analysis of literatures

Date 07 May 2017
Event ELCC 2017
Session SCLC and early stage NSCLC
Topics Non-Small Cell Lung Cancer
Thoracic Malignancies
Presenter Wenhua Liang
Citation Annals of Oncology (2017) 28 (suppl_2): ii20-ii23. 10.1093/annonc/mdx085
Authors W. Liang1, Q. He2, W. Wang2, J. He2
  • 1Department Of Thoracic Surgery/oncology, The 1st Affiliated Hospital of Guangzhou Medical University, 510120 - Guangzhou/CN
  • 2Department Of Thoracic Surgery/oncology, The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou/CN

Abstract

Background

Epidermal growth factor receptor (EGFR) mutation represents a favorable prognostic factor in advanced-stage non-small cell lung cancer (NSCLC), which is predominantly contributed by its good response to EGFR-tyrosine kinase inhibitor. However, its impact on the prognosis of resectable NSCLC after complete surgery, which more closely reflects its natural course, remains controversial. Diverse results have been reported partially due to the small sample size of these studies; small studies bring bias especially in postoperative setting. Therefore, we sought to pool all current evidence to show the true effects.

Methods

Electronic databases were searched for eligible studies. The primary endpoint was disease free survival (DFS), which will be less influenced by subsequent treatments after recurrence. The DFS between EGFR mutated and wild-type patients were compared with special interest in stage I patients who are rarely subjected to adjuvant therapy. In addition, DFS of patients with 19 exon deletion (19del) and 21 exon L858R mutation (L858R) were compared. Random effects models were used.

Results

A total of 13 studies involving 2,652 cases were included; 1033 (39.0%) patients were EGFR-mutated, 47.7% were 19del and 44.1% were L858R. Most studies detected EGFR mutations with PCR-based methods. The DFS of EGFR-mutated patients were similar to wild type patients in overall population (HR 0.87, 95% CI 0.65 to 1.16) and stage I subgroup (HR 0.82, 95% CI 0.40 to 1.69). DFS of 19del patients was potentially inferior to L858R patients but the difference was not significant (HR 1.38, 95% CI 0.76 to 2.52).

Conclusions

EGFR-mutated patients showed no significant difference in postoperative disease-free survival compared with wild-type resected NSCLC. There is still no sufficient evidence to support different postoperative treatment strategy (especially for stage I) for mutated and wild-type patients. However, 19del might be an adverse factor through indirect reasoning, which might require more intensive management. Thus, we strongly encouraged reporting specific prognostic impacts of different mutation types compared with wild-type patients in the following studies.

Clinical trial identification

Legal entity responsible for the study

The clinical research center of the first affiliated hospital of Guangzhou Medical Univeristy

Funding

The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Disclosure

All authors have declared no conflicts of interest.