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. 2021 Aug 31;21(1):977.
doi: 10.1186/s12885-021-08713-8.

Prognostic model of long-term advanced stage (IIIB-IV) EGFR mutated non-small cell lung cancer (NSCLC) survivors using real-life data

Lourdes Gutiérrez  1 , Ana Royuela  2 , Enric Carcereny  3 , Rafael López-Castro  4 , Delvys Rodríguez-Abreu  5 , Bartomeu Massuti  6 , José Luis González-Larriba  7 , Rosario García-Campelo  8 , Joaquim Bosch-Barrera  9 , María Guirado  10 , Carlos Camps  11 , Manuel Dómine  12 , Reyes Bernabé  13 , Joaquín Casal  8 , Juana Oramas  14 , Ana Laura Ortega  15 , Mª Angeles Sala  16 , Airam Padilla  17 , David Aguiar  18 , Oscar Juan-Vidal  19 , Remei Blanco  20 , Edel Del Barco  21 , Natividad Martínez-Banaclocha  6 , Gretel Benítez  5 , Blanca de Vega  4 , Ainhoa Hernández  3 , Maria Saigi  3 , Fernando Franco  22 , Mariano Provencio  22
Affiliations

Prognostic model of long-term advanced stage (IIIB-IV) EGFR mutated non-small cell lung cancer (NSCLC) survivors using real-life data

Lourdes Gutiérrez et al. BMC Cancer. .

Abstract

Background: There is a lack of useful diagnostic tools to identify EGFR mutated NSCLC patients with long-term survival. This study develops a prognostic model using real world data to assist clinicians to predict survival beyond 24 months.

Methods: EGFR mutated stage IIIB and IV NSCLC patients diagnosed between January 2009 and December 2017 included in the Spanish Lung Cancer Group (SLCG) thoracic tumor registry. Long-term survival was defined as being alive 24 months after diagnosis. A multivariable prognostic model was carried out using binary logistic regression and internal validation through bootstrapping. A nomogram was developed to facilitate the interpretation and applicability of the model.

Results: 505 of the 961 EGFR mutated patients identified in the registry were included, with a median survival of 27.73 months. Factors associated with overall survival longer than 24 months were: being a woman (OR 1.78); absence of the exon 20 insertion mutation (OR 2.77); functional status (ECOG 0-1) (OR 4.92); absence of central nervous system metastases (OR 2.22), absence of liver metastases (OR 1.90) or adrenal involvement (OR 2.35) and low number of metastatic sites (OR 1.22). The model had a good internal validation with a calibration slope equal to 0.781 and discrimination (optimism corrected C-index 0.680).

Conclusions: Survival greater than 24 months can be predicted from six pre-treatment clinicopathological variables. The model has a good discrimination ability. We hypothesized that this model could help the selection of the best treatment sequence in EGFR mutation NSCLC patients.

Keywords: EGFR; Long survival; Nomogram; Non-small cell lung cancer; Predictive modeling.

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Conflict of interest statement

The authors LG, EC, RLC, DRA, BM, JLGL, MG, CC, MD, RB, JC, JO, ALO, MAS, AP, DA, RB, EB, NM, GB, BV, AH, MS, FF, AR have no conflict of interest to declare in relation to this study.

RGC reports honoraria, speaker’s bureau, consultant fees from AstraZeneca, Boehringer Ingelheim, BMS, Eli Lilly, MSD, Pfizer, Novartis, Janssen and Takeda, Roche.

JBB reports grants and personal fees from Roche-Genentech and Pfizer; personal fees from MSD, BMS, Astrazeneca, Novartis, and Boehringer-Ingelheim.

OJV reports honoraria from Bristol-Myers Squibb, Roche/Genentech, MSD Oncology, AstraZeneca/MedImmune. Consulting or Advisory Role from Boehringer Ingelheim, Bristol-Myers Squibb, Merck Sharp & Dohme, Roche/Genentech, Lilly, Takeda. Speakers’ Bureau from Roche/Genentech. Travel, Accommodations, Expenses from Roche/Genentech, Merck Sharp & Dohme, Boehringer Ingelheim, Bristol-Myers Squibb.

MP reports grants from BMS, Roche, AstraZeneca and personal fees from BMS, Roche, AstraZeneca, MSD, Takeda. Non-financial support from BMS, Roche, AstraZeneca.

Figures

Fig. 1
Fig. 1
Flow chart of the study population selection
Fig. 2
Fig. 2
Calibration plot and C-statistic value that measures the discrimination. Perfect calibration is shown on the dotted line, and the fit between expected and observed risks is shown on the solid line. The line fits well in most quintiles (represented by the circles), and only deviates when there are a small number of observations (from a predicted risk of 80%)
Fig. 3
Fig. 3
Nomogram of long-term survivors (survival greater than 24 months)
See this image and copyright information in PMC

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References

    1. Zhang Y-L, Yuan J-Q, Wang K-F, Fu X-H, Han X-R, Threapleton D, Yang ZY, Mao C, Tang JL. The prevalence of EGFR mutation in patients with non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2016;7(48):78985–78993. doi: 10.18632/oncotarget.12587. - DOI - PMC - PubMed
    1. Rosell R, Moran T, Queralt C, Porta R, Cardenal F, Camps C, Majem M, Lopez-Vivanco G, Isla D, Provencio M, Insa A, Massuti B, Gonzalez-Larriba JL, Paz-Ares L, Bover I, Garcia-Campelo R, Moreno MA, Catot S, Rolfo C, Reguart N, Palmero R, Sánchez JM, Bastus R, Mayo C, Bertran-Alamillo J, Molina MA, Sanchez JJ, Taron M. Screening for epidermal growth factor receptor mutations in lung Cancer. N Engl J Med. 2009;361(10):958–967. doi: 10.1056/NEJMoa0904554. - DOI - PubMed
    1. Ramalingam SS, Vansteenkiste J, Planchard D, Cho BC, Gray JE, Ohe Y, Zhou C, Reungwetwattana T, Cheng Y, Chewaskulyong B, Shah R, Cobo M, Lee KH, Cheema P, Tiseo M, John T, Lin MC, Imamura F, Kurata T, Todd A, Hodge R, Saggese M, Rukazenkov Y, Soria JC. Overall survival with Osimertinib in untreated, EGFR -mutated advanced NSCLC. N Engl J Med. 2020;382(1):41–50. doi: 10.1056/NEJMoa1913662. - DOI - PubMed
    1. Inoue A, Yoshida K, Morita S, Imamura F, Seto T, Okamoto I, Nakagawa K, Yamamoto N, Muto S, Fukuoka M. Characteristics and overall survival of EGFR mutation-positive non-small cell lung cancer treated with EGFR tyrosine kinase inhibitors: a retrospective analysis for 1660 Japanese patients. Jpn J Clin Oncol. 2016;46(5):462–467. doi: 10.1093/jjco/hyw014. - DOI - PMC - PubMed
    1. Matsuzaki T, Iwami E, Sasahara K, Kuroda A, Nakajima T, Terashima T. A case report of metastatic lung adenocarcinoma with long-term survival for over 11 years. Medicine (Baltimore). 2019;98(4):e14100. 10.1097/MD.0000000000014100. - PMC - PubMed

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