Prognostic impact of pleural effusion in EGFR‐mutant non‐small cell lung cancer patients without brain metastasis

• Published in: Thoracic cancer Vol. 10; no. 3; pp. 557 - 563
• Main Authors: Yoshimura, Akihiro, Yamada, Tadaaki, Tsuji, Taisuke, Hamashima, Ryosuke, Shiotsu, Shinsuke, Yuba, Tatsuya, Takumi, Chieko, Uchino, Junji, Hiraoka, Noriya, Takayama, Koichi
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.03.2019; John Wiley & Sons, Inc; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; Brain cancer; Brain Neoplasms - drug therapy; Brain Neoplasms - pathology; Brain Neoplasms - secondary; Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - genetics; Carcinoma, Non-Small-Cell Lung - pathology; Care and treatment; Chemotherapy; Disease Progression; Epidermal growth factor; Epidermal growth factor receptor; ErbB Receptors - genetics; Female; Gefitinib - administration & dosage; Growth factors; Humans; Kinases; Liver; Liver cancer; Lung cancer; Lung cancer, Non-small cell; Lung cancer, Small cell; Male; Medical imaging; Medical prognosis; Metastasis; Middle Aged; Multivariate analysis; Mutation; Neoplasm Metastasis; NMR; non‐small cell lung cancer; Nuclear magnetic resonance; Original; Patients; pleural effusion; Pleural Effusion - drug therapy; Pleural Effusion - genetics; Pleural Effusion - pathology; Pleural effusions; Prognosis; prognosis factor; Progression-Free Survival; Proportional Hazards Models; Protein Kinase Inhibitors - administration & dosage; Radiation therapy; Studies; Japan; non-small cell lung cancer; pleural effusion; metastasis; prognosis factor; Epidermal growth factor receptor
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.12979

Background In epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC), brain metastasis is known as a poor prognosis factor. However, prognostic factors in the patients without brain metastasis remain unclear. In this study, we aimed to clarify the differences between metastatic site and prognosis in common EGFR‐mutant NSCLC patients without brain metastasis. Methods Chemotherapy‐naïve, advanced EGFR‐mutant NSCLC patients without brain metastasis diagnosed between January 2010 and March 2016 were enrolled. We evaluated prognosis according to the presence or absence of bone metastases, liver metastasis, and pleural effusion. Results A total of 50 EGFR‐mutant NSCLC patients without brain metastasis were enrolled. The median progression‐free survival and overall survival were significantly shorter in patients with pleural effusion than in those patients without (progression‐free survival 7.0 months, 95% confidence interval [CI] 3.7–13.0 vs. 13.0 months, 95% CI 9.1–21.7, hazard ratio [HR] 2.29, 95% CI 1.11–4.73, P = 0.020; overall survival 19.5 months, 95% CI 5.7–28.8 vs. 55.3 months, 95% CI 24.0–not evaluable, HR 3.00, 95% CI 1.35–6.68, P = 0.005). Pleural effusion was an independent factor of poor prognosis for progression‐free survival (HR 3.44, 95% CI 1.50–7.88, P = 0.003) and overall survival (HR 2.34, 95% CI 1.00–5.44, P = 0.049). Conclusion Pleural effusion might be a poor prognosis factor for advanced EGFR‐mutant NSCLC patients without brain metastasis treated with first‐generation EGFR‐tyrosine kinase inhibitors. Further precision medicine according to the metastatic site is required.