文章：

EGFR突变、KRAS突变或无突变肺腺癌患者总生存期趋势分析

Trends in Overall Survival in Lung Adenocarcinoma with EGFR Mutation, KRAS Mutation, or No Mutation

原文发布日期：5 April 2025

DOI: 10.3390/cancers17071237

类型: Article

开放获取: 是

英文摘要：

Background: Treatment of lung adenocarcinoma has changed and now includes checkpoint inhibitors (CPIs) or, in the case of anEGFRmutation, third-generation EGFR TKI osimertinib. Few data compare the long-term overall survival (OS) of current and historic subgroups. Methods: This real-world analysis (KOMPASS study) included stage IV lung-adenocarcinoma patients with either EGFR, KRAS, or no mutation. Patients were assigned to the “current”EGFR,KRAS, or no-mutation cohort if they had mutation testing using NGS (n= 199; median date of diagnosis 2021). If they had an EGFR PCR test only, they were assigned to the “historic”EGFRor no-mutation cohort (n= 127; median date of diagnosis 2014). Results: Both the current and the historicEGFRcohorts had significantly longer OS than the respective no-mutation cohorts (HR 0.58 and 0.60, respectively). The current no-mutation andEGFRcohorts had a strong trend to longer OS than the respective historic cohorts. In the no-mutation cohorts, the improvement was due to an increase in long-term survivors (HR 0.71), whereas in theEGFRmutation cohorts, the median OS was improved without long-term survivors (HR 0.70). TheKRAScohort showed OS like the no-mutation cohort, with a plateau of long-term survivors around 20%. Conclusions: A comparison of our data with that of the phase III trials KEYNOTE-189 and FLAURA suggests that the improved outcomes are due to the use of CPIs or osimertinib. The clinical trial results are well translated into real-world clinical practice with comparable OS.KRASpatients benefit from CPI treatment like no-mutation patients.

摘要翻译： 

背景：肺腺癌的治疗模式已发生转变，目前治疗方案包括免疫检查点抑制剂（CPIs），或在存在EGFR突变的情况下使用第三代EGFR TKI奥希替尼。关于当前与历史亚组长期总生存期（OS）比较的数据较为有限。方法：本真实世界分析（KOMPASS研究）纳入IV期肺腺癌患者，包括EGFR突变、KRAS突变及无突变亚组。若患者采用二代测序（NGS）进行突变检测（n=199；中位诊断时间2021年），则归入“当前”EGFR、KRAS或无突变队列；若仅接受EGFR PCR检测（n=127；中位诊断时间2014年），则归入“历史”EGFR或无突变队列。结果：当前与历史EGFR队列的OS均显著长于对应的无突变队列（风险比分别为0.58和0.60）。当前无突变队列与EGFR队列的OS均呈现优于对应历史队列的显著趋势。在无突变队列中，生存改善主要源于长期生存者比例增加（HR 0.71）；而在EGFR突变队列中，中位OS提升但未出现长期生存者（HR 0.70）。KRAS队列的OS特征与无突变队列相似，长期生存平台期约20%。结论：通过将本研究数据与KEYNOTE-189和FLAURA III期临床试验结果对比，提示生存改善源于CPIs或奥希替尼的应用。临床试验成果在真实世界临床实践中得到良好转化，呈现出可比的OS获益。KRAS突变患者与无突变患者同样能从CPI治疗中获益。

原文链接：

Trends in Overall Survival in Lung Adenocarcinoma with EGFR Mutation, KRAS Mutation, or No Mutation