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Are exon 19 deletions and L858R different in early stage lung adenocarcinoma?

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  • Yiliang Zhang, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Yuan Ma, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Yuan Li, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Xuxia Shen, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Yongfu Yu
  • Yunjian Pan, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Yang Zhang, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Su Yu, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Difan Zheng, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Yue Zhao, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Hong Hu, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Yihua Sun, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Yawei Zhang, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Jiaqing Xiang, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College
  • ,
  • Haiquan Chen, Fudan University Shanghai Cancer Center, Fudan University Shanghai Medical College

Introduction: Evidence shows that exon 19 deletions (19del) and exon 21 Leu858Arg point mutation (L858R) of EGFR are different in response to EGFR tyrosine kinase inhibitor (EGFR-TKI) therapy in advanced lung cancers. However, the impact of the two mutational types in the early stage lung adenocarcinoma is unknown. Methods: We enrolled consecutive patients with operable adenocarcinoma which harbored 19del or L858R to investigate the clinicopathologic characteristics and prognostic outcomes. Results: Between 2008 and 2013, a total of 607 patients with 19del (47.9%) or L858R (52.1%) were included in this study. Clinicopathologic and disease-associated factors were well-balanced between 19del and L858R patients. Both recurrence-free survival (5-year RFS: 37.9% vs. 42.9%, p = 0.075) and overall survival (5-year OS: 64.7% vs. 60.7%, p = 0.741) were similar between the two groups. After relapse, 19del was associated with a better post-recurrence survival (PRS) than L858R (p = 0.016). Multivariate analysis demonstrated that mutational types (HR = 1.521, 95% CI: 1.106–2.093, p = 0.01) and tyrosine kinase inhibitors (TKI) use after recurrence (HR = 0.422, 95% CI: 0.301–0.592, p < 0.001) were independent predictors of PRS. The 19del and L858R patients were similar regarding recurrent patterns, except on pleural/chest wall metastasis (26.0% vs. 12.2%, p = 0.007). Conclusions: Patients with the early stage lung adenocarcinoma harboring either 19del or L858R share similar RFS and OS. After recurrence, both could benefit from TKI therapy without the need for a second biopsy, but 19del seemed to be associated with better PRS.

Original languageEnglish
JournalJournal of Cancer Research and Clinical Oncology
Volume144
Issue1
Pages (from-to)165-171
Number of pages7
ISSN0171-5216
DOIs
Publication statusPublished - 1 Jan 2018

    Research areas

  • Epidermal growth factor receptor (EGFR), Lung adenocarcinoma, Tyrosine kinase inhibitor (TKI)

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