title: Epidermal growth factor receptor mutation, but not sex and smoking, is independently associated with favorable prognosis of gefitinib-treated patients with lung adenocarcinoma.
abstract: Epidermal growth factor receptor (EGFR) mutations have been reported as a predictive factor for favorable prognosis of gefitinib-treated patients with lung adenocarcinoma. However, its confounding with sex and smoking makes it unclear whether the EGFR mutation is independently associated with prolonged patient survival. In this study, we analyzed a large-scale database to discriminate the survival impact of EGFR mutations against those of sex and smoking after gefitinib therapy. EGFR mutations in exon19 and exon21 named drug-sensitive EGFR mutations were examined to investigate the impact of EGFR mutation, sex, and smoking status on survival of 362 gefitinib-treated patients with lung adenocarcinoma. Drug-sensitive EGFR mutations were detected in 169 patients (46.7%). The multivariate analysis including EGFR, sex, and smoking status showed that drug-sensitive EGFR mutations were significantly related to longer overall survival (OS) (P < 0.001) and progression-free survival (PFS) (P < 0.001). In addition, we investigated the impact of sex and smoking status according to EGFR mutation status, and the impact of EGFR mutation status according to sex and smoking status on survival. Sex and smoking status were not significantly associated with longer OS and PFS according to EGFR mutation status. Drug-sensitive EGFR mutations were significantly associated with longer OS and PFS according to sex or smoking status. Our results indicated that drug-sensitive EGFR mutations were the only independent factor for longer survival of patients treated with gefitinib, suggesting that patient selection based on EGFR mutation status for gefitinib therapy will lead to a better outcome for patients with lung adenocarcinoma.
authors.affiliation: Department of Cancer and Thoracic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. toyooka@md.okayama-u.ac.jp
authors.forename: Shinichi
authors.initials: S
authors.lastname: Toyooka
authors.forename: Toshimi
authors.initials: T
authors.lastname: Takano
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kosaka
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Hotta
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.forename: Shuji
authors.initials: S
authors.lastname: Ichihara
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Junichi
authors.initials: J
authors.lastname: Soh
authors.forename: Hiroki
authors.initials: H
authors.lastname: Otani
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kiura
authors.forename: Keisuke
authors.initials: K
authors.lastname: Aoe
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yatabe
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ohe
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mitsudomi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality*; D008297:Male; D009154:Mutation; D011379:Prognosis; D011799:Quinazolines / Q000627:therapeutic use*; D012737:Sex Factors; D012907:Smoking; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D066246:ErbB Receptors; D000077156:Gefitinib