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Open AccessArticle

Benefit from Adjuvant TKIs Versus TKIs Plus Chemotherapy in EGFR-Mutant Stage III-pN2 Lung Adenocarcinoma

1
State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
2
Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
3
State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University/National Clinical Research Center of Respiratory Disease, Guangzhou 510060, China
4
State Key Laboratory of Oncology in South China, Department of Pathology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
5
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
6
Union Hospital Cancer Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
7
State Key Laboratory of Oncology in South China, Department of Thoracic Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
*
Author to whom correspondence should be addressed.
These two authors contributed equally to this work.
Curr. Oncol. 2021, 28(2), 1424-1436; https://doi.org/10.3390/curroncol28020135
Received: 14 May 2020 / Revised: 4 November 2020 / Accepted: 4 November 2020 / Published: 7 April 2021
Background: Recent studies have demonstrated benefits from adjuvant tyrosine-kinase inhibitors (TKIs) compared with chemotherapy in non-small cell lung cancer. We launched a multi-center retrospective study to evaluate the efficacy and toxicity of adjuvant TKIs with or without chemotherapy in epidermal growth factor receptor (EGFR)-mutant stage III-pN2 lung adenocarcinoma. Methods: Two hundred and seventy-four consecutive cases with stage III-pN2 lung adenocarcinoma and complete resection have been investigated. Clinic-pathologic characteristics, adjuvant treatments, long-term survivals, and toxicities were documented. Risk factors of distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were evaluated. Results: There were 52 (19.0%) patients treated with adjuvant TKIs alone, 199 (72.6%) with adjuvant chemotherapy alone, and 23 (8.4%) with both. After a median follow-up time of 29 months, the two-year DMFS, DFS, and OS was 61.2%, 54.1%, and 91.2%, respectively. According to univariable analyses, the risk factors were lymphovascular invasion (p < 0.001), extranodal extension (p = 0.005), and adjuvant systemic therapy (p = 0.006) for DMFS, EGFR mutation type (p = 0.025), lymphovascular invasion (p = 0.013), extranodal extension (p = 0.004), and adjuvant systemic therapy (p < 0.001) for DFS, and EGFR mutation type (p < 0.001) for OS. Multivariable analyses indicated that the independent prognostic factors were adjuvant systemic therapy (TKIs vs. TKIs+chemotherapy, Harzard ratio (HR) = 0.40; p = 0.036; TKIs vs. chemotherapy, HR = 0.38; p = 0.004), lymphovascular invasion (yes vs. no, HR = 2.22; p = 0.001) for DMFS, and adjuvant systemic therapy (TKIs vs. TKIs+chemotherapy, HR = 0.42; p = 0.034; TKIs vs. chemotherapy, HR = 0.33; p < 0.001) for DFS. No significant difference was found in the incidence of Grade 3–4 toxicities between groups (p = 0.445). Conclusions: Adjuvant TKIs might be a beneficial choice compared with adjuvant chemotherapy or combination systemic treatments. View Full-Text
Keywords: lung adenocarcinoma; N2; EGFR mutation; adjuvant TKIs; chemotherapy lung adenocarcinoma; N2; EGFR mutation; adjuvant TKIs; chemotherapy
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MDPI and ACS Style

Li, Q.; Ma, L.; Qiu, B.; Wen, Y.; Liang, W.; Hu, W.; Chen, N.; Zhang, T.; Xu, S.; Chen, L.; Guo, M.; Zhao, Y.; Liu, S.; Guo, J.; Wang, J.; Wang, S.; Wang, X.; Pang, Q.; Long, H.; Liu, H. Benefit from Adjuvant TKIs Versus TKIs Plus Chemotherapy in EGFR-Mutant Stage III-pN2 Lung Adenocarcinoma. Curr. Oncol. 2021, 28, 1424-1436. https://doi.org/10.3390/curroncol28020135

AMA Style

Li Q, Ma L, Qiu B, Wen Y, Liang W, Hu W, Chen N, Zhang T, Xu S, Chen L, Guo M, Zhao Y, Liu S, Guo J, Wang J, Wang S, Wang X, Pang Q, Long H, Liu H. Benefit from Adjuvant TKIs Versus TKIs Plus Chemotherapy in EGFR-Mutant Stage III-pN2 Lung Adenocarcinoma. Current Oncology. 2021; 28(2):1424-1436. https://doi.org/10.3390/curroncol28020135

Chicago/Turabian Style

Li, Qiwen; Ma, Li; Qiu, Bo; Wen, Yuzhi; Liang, Wenhua; Hu, Wanming; Chen, Naibin; Zhang, Tian; Xu, Shuangbing; Chen, Lingjuan; Guo, Minzhang; Zhao, Yi; Liu, Songran; Guo, Jinyu; Wang, Junye; Wang, Siyu; Wang, Xin; Pang, Qingsong; Long, Hao; Liu, Hui. 2021. "Benefit from Adjuvant TKIs Versus TKIs Plus Chemotherapy in EGFR-Mutant Stage III-pN2 Lung Adenocarcinoma" Curr. Oncol. 28, no. 2: 1424-1436. https://doi.org/10.3390/curroncol28020135

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