Background: The efficacy of local therapies for lung cancer patients with postoperative oligo-recurrence has been reported. However, whether local therapies should be chosen over molecular targeted therapies for oligo-recurrence patients with driver mutations remains controversial. Therefore, we aimed to investigate the optimal initial treatment strategy for oligo-recurrence in lung cancer patients with driver mutations. Methods: Among 2152 patients with lung adenocarcinoma who underwent surgical resection at our institute between 2008 and 2020, 66 patients with driver mutations who experienced cancer oligo-recurrence after surgery and were treated with local or molecularly targeted therapy as an initial therapy after recurrence were evaluated. Oligo-recurrence was characterized by the presence of 1 to 3 recurrent lesions. These patients were investigated, focusing on their post-recurrence therapies and prognoses. Results: The median follow-up period was 71 months. Local and molecular targeted therapies were administered to 41 and 25 patients, respectively. The number of recurrence lesions tended to be lower in the initial local therapy group than in the molecular targeted therapy group. In the initial local therapy group, 23 patients (56%) subsequently received molecular targeted therapies. The time from recurrence to the initiation of molecular targeted therapy was significantly longer in the local therapy group than in the molecular targeted therapy group (p< 0.001). There was no significant difference in post-recurrence overall survival (hazard ratio, 1.429; 95% confidence interval, 0.701–2.912; log-rank,p= 0.324) and post-recurrence progression-free survival (hazard ratio, 0.799; 95% confidence interval, 0.459–1.390; log-rank,p= 0.426) in the initial local ablative therapy group compared with the initial molecular targeted therapy group. Conclusions: Local therapies as a first-line treatment did not show statistically significant differences in post-recurrence survival or progression-free survival compared with molecular targeted therapies. However, local therapies as an initial treatment should be considered preferably, as they can cure the recurrence and can delay the start of administration of molecular targeted therapies.
背景：局部治疗对肺癌术后寡复发患者的疗效已有报道。然而，对于存在驱动基因突变的寡复发患者，是否应优先选择局部治疗而非分子靶向治疗仍存在争议。因此，本研究旨在探讨伴有驱动基因突变的肺癌患者发生寡复发时的最佳初始治疗策略。方法：本研究回顾性分析了2008年至2020年间在我院接受手术切除的2152例肺腺癌患者，筛选出66例术后发生寡复发、携带驱动基因突变且在复发后首次接受局部治疗或分子靶向治疗的患者。寡复发的定义为存在1至3个复发病灶。研究重点分析了这些患者的复发后治疗及预后情况。结果：中位随访时间为71个月。其中41例患者接受初始局部治疗，25例接受初始分子靶向治疗。初始局部治疗组的复发病灶数量倾向于少于分子靶向治疗组。在初始局部治疗组中，有23例患者（56%）后续接受了分子靶向治疗。局部治疗组从复发到开始分子靶向治疗的时间显著长于分子靶向治疗组（p<0.001）。与初始分子靶向治疗组相比，初始局部消融治疗组的复发后总生存期（风险比1.429；95%置信区间0.701–2.912；对数秩检验p=0.324）和复发后无进展生存期（风险比0.799；95%置信区间0.459–1.390；对数秩检验p=0.426）均无显著差异。结论：作为一线治疗，局部治疗与分子靶向治疗相比，在复发后生存期或无进展生存期方面未显示出统计学显著差异。然而，初始治疗应优先考虑局部治疗，因为它可能治愈复发病灶，并可延迟分子靶向治疗的开始时间。
Optimal Treatment Strategy for Oligo-Recurrence Lung Cancer Patients with Driver Mutations
肿瘤(癌症)患者之家