Thoracic surgery may improve overall survival (OS) in patients with unresectable stage IIIB-IV EGFR-mutant lung adenocarcinoma who responded to treatment with a tyrosine kinase inhibitor (TKI), according to research published in Lung Cancer.

The study showed that patients who underwent surgery after EGFR-TKI treatment had significantly better OS than patients who continued on EGFR-TKI treatment alone until disease progression.

Researchers conducted this population-based cohort study using data from the Taiwan Cancer Registry Database. The study included 1395 matched patients — 279 in the surgery group and 1116 in the TKI-alone group.


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At baseline, the mean age was 60.20 years in the surgery group and 60.41 years in the TKI-alone group. More than half of patients in each group (57.7% and 57.2%, respectively) were women.

The mean follow-up was 4.86 years in the surgery group and 3.73 years in the TKI-alone group (P <.0001).

The 5-year OS rate was 39.77% in the surgery group and 21.97% in the TKI-alone group. The adjusted hazard ratio (aHR) for all-cause death was 0.445 (95% CI, 0.351-0.564; P <.0001) in the surgery group vs the TKI-alone group.

For patients younger than 65 years of age, the 5-year OS was 31.17% in the surgery group and 18.71% in the TKI-alone group. The aHR for all-cause death was 0.492 (95% CI, 0.379-0.640; P <.0001) in the surgery group vs the TKI-alone group.

For patients age 65 or older, the 5-year OS was 61.21% in the surgery group and 19.74% in the TKI-alone group. The aHR for all-cause death was 0.347 (95% CI, 0.209-0.575; P <.0001) in the surgery group vs the TKI-alone group.

The researchers acknowledged a few limitations of this study, including potential selection bias and residual, unmeasured confounding. Additionally, complications caused by thoracic surgery could not be determined, so treatment-related mortality estimates may have been biased.

Furthermore, all patients were Asian, the database did not provide information on non-EGFR mutations, and the diagnoses of all comorbidities were dependent on International Classification of Diseases, Tenth Revision, Clinical Modification codes.

Reference

Chien Y-N, Lin Y-C, Chang C-L, Lin W-C, Wu S-Y. Thoracic surgery improved overall survival in patients with stage IIIB–IV epidermal growth factor receptor-mutant lung adenocarcinoma who received and responded to tyrosine kinase inhibitor treatment. Lung Cancer. 2021;162:29-35. doi: 10.1016/j.lungcan.2021.10.003