Presence of pleural effusion is associated with a poor prognosis in patients with epidermal growth factor receptor–mutated lung cancer receiving tyrosine kinase inhibitors as first-line treatment

Tso Fu Wang, Sung Chao Chu, Jen Jyh Lee, Gee Gwo Yang, Wei Han Huang, En Ting Chang, Tissot Low, Yi Feng Wu, Ruey Ho Kao, Chih Bin Lin

Research output: Contribution to journalArticle

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Abstract

Aim: This study was conducted to evaluate the effect of clinical factors on the treatment outcomes of lung cancer patients with active epidermal growth factor receptor (EGFR) mutations treated by first-line tyrosine kinase inhibitors (TKIs). Methods: Patients of stage IIIb or IV lung adenocarcinoma harboring mutated EGFR were enrolled between March 2010 and June 2014 and followed up until December 2015. The effects of various clinical features, such as age, sex, smoking history, EGFR mutation types, TKIs used, presence of pleural effusion, metastatic sites on progression-free survival (PFS) and overall survival (OS), were analyzed retrospectively. Results: A total of 104 patients were included in this study. Patients with pleural effusion at initial diagnosis had significantly shorter PFS and OS than those without pleural effusion (median PFS: 8.2 months vs 15.3 months, P = 0.0004; median OS: 16.3 months vs 28.2 months, P = 0.0003). Univariate analysis revealed that being male or a smoker was associated with short PFS, whereas smoking history, bony metastasis and malignant pleural effusion were associated with poor OS. Stepwise multivariate Cox regression analysis showed that the presence of pleural effusion and different TKI use were independent prognostic factors for PFS [hazard ratio [HR] = 2.50 (95% confidence interval [CI], 1.53–4.10), P = 0.0003 and HR = 0.55 (95% CI, 0.31–0.97), P = 0.0396, respectively], whereas the presence of pleural effusion and liver metastasis were associated with poor OS [HR = 2.79 (95% CI: 1.46–5.30), P = 0.0018 and HR = 2.12 (95% CI, 1.02–4.40), P = 0.0440, respectively]. Conclusion: The presence of pleural effusion predicts poor PFS and OS in lung adenocarcinoma patients receiving TKIs as the first-line treatment. Additional studies are warranted to elucidate the underlying mechanisms and determine novel strategies for improving the outcome of these patients.

Original languageEnglish
Pages (from-to)304-313
Number of pages10
JournalAsia-Pacific Journal of Clinical Oncology
Volume13
Issue number4
DOIs
Publication statusPublished - Aug 1 2017
Externally publishedYes

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Pleural Effusion
Epidermal Growth Factor
Protein-Tyrosine Kinases
Disease-Free Survival
Lung Neoplasms
Survival
Epidermal Growth Factor Receptor
Confidence Intervals
Therapeutics
Smoking
History
Neoplasm Metastasis
Malignant Pleural Effusion
Mutation
Regression Analysis
Liver

Keywords

  • pleural effusion
  • prognosis
  • tyrosine kinase inhibitor

ASJC Scopus subject areas

  • Oncology

Cite this

Presence of pleural effusion is associated with a poor prognosis in patients with epidermal growth factor receptor–mutated lung cancer receiving tyrosine kinase inhibitors as first-line treatment. / Wang, Tso Fu; Chu, Sung Chao; Lee, Jen Jyh; Yang, Gee Gwo; Huang, Wei Han; Chang, En Ting; Low, Tissot; Wu, Yi Feng; Kao, Ruey Ho; Lin, Chih Bin.

In: Asia-Pacific Journal of Clinical Oncology, Vol. 13, No. 4, 01.08.2017, p. 304-313.

Research output: Contribution to journalArticle

Wang, Tso Fu ; Chu, Sung Chao ; Lee, Jen Jyh ; Yang, Gee Gwo ; Huang, Wei Han ; Chang, En Ting ; Low, Tissot ; Wu, Yi Feng ; Kao, Ruey Ho ; Lin, Chih Bin. / Presence of pleural effusion is associated with a poor prognosis in patients with epidermal growth factor receptor–mutated lung cancer receiving tyrosine kinase inhibitors as first-line treatment. In: Asia-Pacific Journal of Clinical Oncology. 2017 ; Vol. 13, No. 4. pp. 304-313.
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abstract = "Aim: This study was conducted to evaluate the effect of clinical factors on the treatment outcomes of lung cancer patients with active epidermal growth factor receptor (EGFR) mutations treated by first-line tyrosine kinase inhibitors (TKIs). Methods: Patients of stage IIIb or IV lung adenocarcinoma harboring mutated EGFR were enrolled between March 2010 and June 2014 and followed up until December 2015. The effects of various clinical features, such as age, sex, smoking history, EGFR mutation types, TKIs used, presence of pleural effusion, metastatic sites on progression-free survival (PFS) and overall survival (OS), were analyzed retrospectively. Results: A total of 104 patients were included in this study. Patients with pleural effusion at initial diagnosis had significantly shorter PFS and OS than those without pleural effusion (median PFS: 8.2 months vs 15.3 months, P = 0.0004; median OS: 16.3 months vs 28.2 months, P = 0.0003). Univariate analysis revealed that being male or a smoker was associated with short PFS, whereas smoking history, bony metastasis and malignant pleural effusion were associated with poor OS. Stepwise multivariate Cox regression analysis showed that the presence of pleural effusion and different TKI use were independent prognostic factors for PFS [hazard ratio [HR] = 2.50 (95{\%} confidence interval [CI], 1.53–4.10), P = 0.0003 and HR = 0.55 (95{\%} CI, 0.31–0.97), P = 0.0396, respectively], whereas the presence of pleural effusion and liver metastasis were associated with poor OS [HR = 2.79 (95{\%} CI: 1.46–5.30), P = 0.0018 and HR = 2.12 (95{\%} CI, 1.02–4.40), P = 0.0440, respectively]. Conclusion: The presence of pleural effusion predicts poor PFS and OS in lung adenocarcinoma patients receiving TKIs as the first-line treatment. Additional studies are warranted to elucidate the underlying mechanisms and determine novel strategies for improving the outcome of these patients.",
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T1 - Presence of pleural effusion is associated with a poor prognosis in patients with epidermal growth factor receptor–mutated lung cancer receiving tyrosine kinase inhibitors as first-line treatment

AU - Wang, Tso Fu

AU - Chu, Sung Chao

AU - Lee, Jen Jyh

AU - Yang, Gee Gwo

AU - Huang, Wei Han

AU - Chang, En Ting

AU - Low, Tissot

AU - Wu, Yi Feng

AU - Kao, Ruey Ho

AU - Lin, Chih Bin

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Aim: This study was conducted to evaluate the effect of clinical factors on the treatment outcomes of lung cancer patients with active epidermal growth factor receptor (EGFR) mutations treated by first-line tyrosine kinase inhibitors (TKIs). Methods: Patients of stage IIIb or IV lung adenocarcinoma harboring mutated EGFR were enrolled between March 2010 and June 2014 and followed up until December 2015. The effects of various clinical features, such as age, sex, smoking history, EGFR mutation types, TKIs used, presence of pleural effusion, metastatic sites on progression-free survival (PFS) and overall survival (OS), were analyzed retrospectively. Results: A total of 104 patients were included in this study. Patients with pleural effusion at initial diagnosis had significantly shorter PFS and OS than those without pleural effusion (median PFS: 8.2 months vs 15.3 months, P = 0.0004; median OS: 16.3 months vs 28.2 months, P = 0.0003). Univariate analysis revealed that being male or a smoker was associated with short PFS, whereas smoking history, bony metastasis and malignant pleural effusion were associated with poor OS. Stepwise multivariate Cox regression analysis showed that the presence of pleural effusion and different TKI use were independent prognostic factors for PFS [hazard ratio [HR] = 2.50 (95% confidence interval [CI], 1.53–4.10), P = 0.0003 and HR = 0.55 (95% CI, 0.31–0.97), P = 0.0396, respectively], whereas the presence of pleural effusion and liver metastasis were associated with poor OS [HR = 2.79 (95% CI: 1.46–5.30), P = 0.0018 and HR = 2.12 (95% CI, 1.02–4.40), P = 0.0440, respectively]. Conclusion: The presence of pleural effusion predicts poor PFS and OS in lung adenocarcinoma patients receiving TKIs as the first-line treatment. Additional studies are warranted to elucidate the underlying mechanisms and determine novel strategies for improving the outcome of these patients.

AB - Aim: This study was conducted to evaluate the effect of clinical factors on the treatment outcomes of lung cancer patients with active epidermal growth factor receptor (EGFR) mutations treated by first-line tyrosine kinase inhibitors (TKIs). Methods: Patients of stage IIIb or IV lung adenocarcinoma harboring mutated EGFR were enrolled between March 2010 and June 2014 and followed up until December 2015. The effects of various clinical features, such as age, sex, smoking history, EGFR mutation types, TKIs used, presence of pleural effusion, metastatic sites on progression-free survival (PFS) and overall survival (OS), were analyzed retrospectively. Results: A total of 104 patients were included in this study. Patients with pleural effusion at initial diagnosis had significantly shorter PFS and OS than those without pleural effusion (median PFS: 8.2 months vs 15.3 months, P = 0.0004; median OS: 16.3 months vs 28.2 months, P = 0.0003). Univariate analysis revealed that being male or a smoker was associated with short PFS, whereas smoking history, bony metastasis and malignant pleural effusion were associated with poor OS. Stepwise multivariate Cox regression analysis showed that the presence of pleural effusion and different TKI use were independent prognostic factors for PFS [hazard ratio [HR] = 2.50 (95% confidence interval [CI], 1.53–4.10), P = 0.0003 and HR = 0.55 (95% CI, 0.31–0.97), P = 0.0396, respectively], whereas the presence of pleural effusion and liver metastasis were associated with poor OS [HR = 2.79 (95% CI: 1.46–5.30), P = 0.0018 and HR = 2.12 (95% CI, 1.02–4.40), P = 0.0440, respectively]. Conclusion: The presence of pleural effusion predicts poor PFS and OS in lung adenocarcinoma patients receiving TKIs as the first-line treatment. Additional studies are warranted to elucidate the underlying mechanisms and determine novel strategies for improving the outcome of these patients.

KW - pleural effusion

KW - prognosis

KW - tyrosine kinase inhibitor

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