Cancer Res Treat.  2023 Apr;55(2):498-505. 10.4143/crt.2022.388.

EGFR Mutation–Positive Unresectable Stage III Non-Squamous Lung Cancer Is Associated with a High Incidence of Brain Metastasis

• Kim H
• Park S
• Jung HA
• Sun JM
• Lee SH
• Ahn JS
• Ahn MJ

• KMID: 2541236
• DOI: http://doi.org/10.4143/crt.2022.388

Abstract

Purpose
The impact of epidermal growth factor receptor (EGFR) mutation in locally advanced non–small cell lung cancer (NSCLC) remains controversial. This study was conducted to investigate the clinical outcomes and recurrence patterns after definitive chemoradiotherapy (CRT) in patients with unresectable stage III non-squamous-cell lung cancer according to EGFR mutation status.
Materials and Methods
We retrospectively reviewed 604 patients with pathologically confirmed stage III NSCLC who were treated with definitive CRT and were examined for EGFR mutation at Samsung Medical Center, Korea, from January 2013 to December 2018. Among them, we identified 236 patients with stage III non-squamous-cell lung cancer who were treated with definitive CRT and were examined for EGFR mutation status. We analyzed the frequency of EGFR mutation, progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and recurrence pattern.
Results
Among 236 patients, EGFR mutation was detected in 71 patients (30.1%) and the median follow-up duration was 41.7 months. There were no significant differences in PFS (9.9 vs. 10.9 months, p=0.236), and ORR to CRT (93.0% vs. 90.3%, p=0.623) according to EGFR mutation status. However, the EGFR mutant group showed significantly higher recurrence (88.7% vs. 75.2%, p=0.022), distant metastasis (76.1% vs. 61.2%, p=0.036) rates, especially brain (38.0% vs. 12.7%, p < 0.001), and better median OS (59.2 vs. 41.3 months, p=0.037) compared with patients without EGFR mutation.
Conclusion
Patients with EGFR mutation–positive unresectable stage III non-squamous lung cancer exhibited higher recurrence and distant metastasis rates, especially brain metastasis.

Keyword

Non-small-cell lung carcinoma; mutation; Chemoradiotherapy; Metastasis; Survival

Figure

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  Fig. 1 Flow diagram of the study population. CRT, chemoradiotherapy; EGFR, epidermal growth factor receptor; NSCLC, non–small cell lung cancer.

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  Fig. 2 Kaplan-Meier curves of progression-free survival (A) and overall survival (B) according to epidermal growth factor receptor (EGFR) mutation status. CI, confidence interval.

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  Fig. 3 Kaplan-Meier survival curves of progression-free survival (A) and overall survival (B) according to epidermal growth factor receptor (EGFR) mutation subtypes. CI, confidence interval.

Reference

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