Evaluating the Impact of Primary Tumor Resection on EGFR-TKI-treated Patients with Advanced Lung Cancer: A Multicenter Propensity-matched Study
Background: Nonsmall-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations is exceptionally sensitive to EGFR tyrosine kinase inhibitors (TKIs). Despite this, disease progression commonly occurs at the primary site, prompting debate on the potential advantages of incorporat...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-04-01
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| Series: | Journal of Cancer Research and Practice |
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| Online Access: | https://journals.lww.com/10.4103/ejcrp.eJCRP-D-24-00037 |
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| author | Eva Yu-Hsuan Chuang Chiao-En Wu Tzu-Wei Kuo Yu-Wen Wen Ping-Chih Hsu Chih-Hsi Scott Kuo Cheng-Ta Yang Ling-Jen Hung Yin-Kai Chao |
| author_facet | Eva Yu-Hsuan Chuang Chiao-En Wu Tzu-Wei Kuo Yu-Wen Wen Ping-Chih Hsu Chih-Hsi Scott Kuo Cheng-Ta Yang Ling-Jen Hung Yin-Kai Chao |
| author_sort | Eva Yu-Hsuan Chuang |
| collection | DOAJ |
| description | Background:
Nonsmall-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations is exceptionally sensitive to EGFR tyrosine kinase inhibitors (TKIs). Despite this, disease progression commonly occurs at the primary site, prompting debate on the potential advantages of incorporating primary tumor resection alongside standard maintenance therapy.
Materials and Methods:
This retrospective multicenter study enrolled NSCLC patients treated with EGFR-TKIs and categorized them into surgery and control groups based on primary tumor resection. The propensity score matching (PSM) method was used to ensure balanced comparisons, accounting for 12 covariates. Progression-free survival (PFS) and overall survival (OS) were evaluated, addressing immortal time bias.
Results:
Among 2151 EGFR-TKI-treated patients screened from 2010 to 2019, 57 (21 surgery group, 36 control group) were included post-PSM and accounting for immortal time bias. No cases of major complications (grade IIIa or higher based on Clavien-Dindo criteria) or 90-day mortality were noted in the surgery group. Pulmonary resection was significantly associated with longer PFS (58.6 vs. 14.1 months, P = 0.001) and OS (109.6 vs. 46.6 months, P = 0.016) compared to EGFR-TKI monotherapy. Positive outcomes were consistent across diverse subgroups.
Conclusion:
The addition of primary tumor resection in EGFR-mutant NSCLC patients receiving EGFR-TKI treatment was associated with improved PFS and OS compared to EGFR-TKI treatment alone. However, these results should be interpreted with caution due to potential selection bias in the analysis. |
| format | Article |
| id | doaj-art-f73e967ef7844fcf85d2d4c4920caefe |
| institution | Matheson Library |
| issn | 2311-3006 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Cancer Research and Practice |
| spelling | doaj-art-f73e967ef7844fcf85d2d4c4920caefe2025-07-05T07:28:28ZengWolters Kluwer Medknow PublicationsJournal of Cancer Research and Practice2311-30062025-04-01122404810.4103/ejcrp.eJCRP-D-24-00037Evaluating the Impact of Primary Tumor Resection on EGFR-TKI-treated Patients with Advanced Lung Cancer: A Multicenter Propensity-matched StudyEva Yu-Hsuan ChuangChiao-En WuTzu-Wei KuoYu-Wen WenPing-Chih HsuChih-Hsi Scott KuoCheng-Ta YangLing-Jen HungYin-Kai ChaoBackground: Nonsmall-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations is exceptionally sensitive to EGFR tyrosine kinase inhibitors (TKIs). Despite this, disease progression commonly occurs at the primary site, prompting debate on the potential advantages of incorporating primary tumor resection alongside standard maintenance therapy. Materials and Methods: This retrospective multicenter study enrolled NSCLC patients treated with EGFR-TKIs and categorized them into surgery and control groups based on primary tumor resection. The propensity score matching (PSM) method was used to ensure balanced comparisons, accounting for 12 covariates. Progression-free survival (PFS) and overall survival (OS) were evaluated, addressing immortal time bias. Results: Among 2151 EGFR-TKI-treated patients screened from 2010 to 2019, 57 (21 surgery group, 36 control group) were included post-PSM and accounting for immortal time bias. No cases of major complications (grade IIIa or higher based on Clavien-Dindo criteria) or 90-day mortality were noted in the surgery group. Pulmonary resection was significantly associated with longer PFS (58.6 vs. 14.1 months, P = 0.001) and OS (109.6 vs. 46.6 months, P = 0.016) compared to EGFR-TKI monotherapy. Positive outcomes were consistent across diverse subgroups. Conclusion: The addition of primary tumor resection in EGFR-mutant NSCLC patients receiving EGFR-TKI treatment was associated with improved PFS and OS compared to EGFR-TKI treatment alone. However, these results should be interpreted with caution due to potential selection bias in the analysis.https://journals.lww.com/10.4103/ejcrp.eJCRP-D-24-00037epidermal growth factor receptorlocal consolidation therapynonsmall-cell lung cancerprimary tumor resectionprogression-free survivaltyrosine kinase inhibitors |
| spellingShingle | Eva Yu-Hsuan Chuang Chiao-En Wu Tzu-Wei Kuo Yu-Wen Wen Ping-Chih Hsu Chih-Hsi Scott Kuo Cheng-Ta Yang Ling-Jen Hung Yin-Kai Chao Evaluating the Impact of Primary Tumor Resection on EGFR-TKI-treated Patients with Advanced Lung Cancer: A Multicenter Propensity-matched Study Journal of Cancer Research and Practice epidermal growth factor receptor local consolidation therapy nonsmall-cell lung cancer primary tumor resection progression-free survival tyrosine kinase inhibitors |
| title | Evaluating the Impact of Primary Tumor Resection on EGFR-TKI-treated Patients with Advanced Lung Cancer: A Multicenter Propensity-matched Study |
| title_full | Evaluating the Impact of Primary Tumor Resection on EGFR-TKI-treated Patients with Advanced Lung Cancer: A Multicenter Propensity-matched Study |
| title_fullStr | Evaluating the Impact of Primary Tumor Resection on EGFR-TKI-treated Patients with Advanced Lung Cancer: A Multicenter Propensity-matched Study |
| title_full_unstemmed | Evaluating the Impact of Primary Tumor Resection on EGFR-TKI-treated Patients with Advanced Lung Cancer: A Multicenter Propensity-matched Study |
| title_short | Evaluating the Impact of Primary Tumor Resection on EGFR-TKI-treated Patients with Advanced Lung Cancer: A Multicenter Propensity-matched Study |
| title_sort | evaluating the impact of primary tumor resection on egfr tki treated patients with advanced lung cancer a multicenter propensity matched study |
| topic | epidermal growth factor receptor local consolidation therapy nonsmall-cell lung cancer primary tumor resection progression-free survival tyrosine kinase inhibitors |
| url | https://journals.lww.com/10.4103/ejcrp.eJCRP-D-24-00037 |
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