Abstract:

Objective
To compare the  clinical effects of  epidermal growth factor receptor tyrosine kinase inhibitors(FGFR-TKI) between the advanced lung adenocarcinoma patients with unknown epidermal growth factor receptor(EGFR) mutation status　and mutation  advantage   whose  performance status(PS) score was 2 and the patients with  postive EGFR mutation,  and  to explore wether the clinical features of mutation advantage  can guide  the TKI treatment or not.Methods 70 lung adenocarcinoma patients’ clinical data,who were confirmed ⅢB-Ⅳ stage,PS score was 2,and treated with first-line TKI therapy, were analyzed retrospectivly.There were 35 cases of positive EGFR mutation   and  35 cases of unknown EGFR mutation status  but with mutation  advantage.Kaplan-Meier method was used to draw the survival curve and Log-rank test was used to analyze the progression-free survival(PFS),overall survival(OS), and survival rates of the patients in two groups. Results The median PFS of  positive  EGFR mutation patients was 8.2 months,and it was 6.3 months in the patients with   EGFR unknown mutation status  but with mutation advantage.There was significant difference of the median PFS  between  two groups (P=0.043);the median OS of the  positive EGFR mutation patients was 17.1 months,and it was 9.4 months in the patients with  unknown  EGFR mutation status  but with  mutation advantage.There was significant difference of the median OS between  two groups (P=0.044); 1-year and 2-year survival rates of the positive  EGFR mutation patients  were 57.1% and 31.4%,and they were 37.1% and 20.0% in the patients with     unknown EGFR mutation status but with mutation advantage.There was significant difference of the survival rate between  two groups (P=0.047,P=0.049);the subgroup analysis results showed that the median PFS of the female (P=0.003),>60 years (P=0.048),without  smoking history (P=0.012),and  clinical stage  Ⅳ(P=0.049) patients in positive EGFR mutation group were higher than those of the patients in  unknoun EGFR mutation status but with  mutation advantage group.Conclusion The advanced lung adenocarcinoma  patients whose PS score was 2 with positive  EGFR mutation   have better clinical effect than the patients with  unknown  EGFR mutation status but with  advantage  when fist-line treated with  EGFR-TKI;the  female,>60 years,without smoking history,and clinical stage Ⅳ  are  the important factors of  median PFS.