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. 2021 May 17:13:3981-3990.
doi: 10.2147/CMAR.S302545. eCollection 2021.

Adenocarcinoma of High-Grade Patterns Associated with Distinct Outcome of First-Line Chemotherapy or EGFR-TKIs in Patients of Relapsed Lung Cancer

Xiaofei Yu #  1 , Zhengwei Dong #  2 , Wanying Wang  1 , Shiqi Mao  1 , Yingying Pan  1 , Yiwei Liu  1 , Shuo Yang  1 , Bin Chen  1 , Chunyan Wang  1 , Xuefei Li  3 , Chao Zhao  3 , Keyi Jia  1 , Chuchu Shao  1 , Chunyan Wu  2 , Shengxiang Ren  1 , Caicun Zhou  1
Affiliations

Adenocarcinoma of High-Grade Patterns Associated with Distinct Outcome of First-Line Chemotherapy or EGFR-TKIs in Patients of Relapsed Lung Cancer

Xiaofei Yu et al. Cancer Manag Res. .

Abstract

Purpose: High-grade patterns (micropapillary/solid/complex gland) are associated with a higher recurrence rate and shorter disease-free survival. Thus far, it remains unclear whether the efficacy of first-line anticancer therapy is different from that of the other adenocarcinoma subgroups for patients with high-grade patterns. The study aimed to investigate the association between an adenocarcinoma with high-grade patterns with the outcomes of first-line treatment in patients with lung cancer.

Patients and methods: Patients with a high-grade pattern adenocarcinoma (more than 20% of micropapillary/solid components/complex glandular patterns) were retrospectively analyzed between June 2015 and June 2017. Patients' clinical characteristics and treatment outcomes were compared with those of the remaining control adenocarcinoma subgroups.

Results: In total, 239 patients with adenocarcinoma, including 115 (48.1%) high-grade patterns and 124 (51.9%) control groups, were enrolled. Patients' clinical characteristics such as age, sex, smoking status, and stage were similar between the two groups. Among them, 108 patients received first-line chemotherapy, and 131 received epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs). In the chemotherapy group, adenocarcinoma of high-grade patterns had a significantly lower objective response rate (ORR; 15.6% vs 36.4%, P=0.045), shorter progression-free survival (PFS; median 4.1 vs 5.4 months, P=0.007) and overall survival (OS, median 19.6 vs 23.8 months, P=0.048) compared with the control group. As for these treated with EGFR-TKIs, a similar ORR (70.7% vs 72.1%, P=0.703), PFS (median 11.3 vs 13.9 months, P=0.065) and OS (median 34.1 vs 29.6%, p=0.575) were observed between these two groups.

Conclusion: An adenocarcinoma with high-grade patterns is associated with inferior outcomes to first-line chemotherapy in relapsed lung cancer. Patients who received chemotherapy had a significantly shorter PFS and OS and lower ORR than control subjects, while there was no difference in the EGFR-TKI cohort. This study is the first to report the distribution of adenocarcinoma with high-grade patterns.

Keywords: EGFR-TKIs; adenocarcinoma; chemotherapy; micropapillary; solid.

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Conflict of interest statement

The authors report no conflicts of interest or financial interest in this work.

Figures

Figure 1
Figure 1
Distribution of histological subtypes in relapsed patients.
Figure 2
Figure 2
Flowchart of the patient selection process.
Figure 3
Figure 3
Kaplan-Meier survival curves for patients in different cohorts. (A) Progression-free survival (PFS) of first-line chemotherapy in epidermal growth factor receptor (EGFR) wild-type patients with high-grade patterns and in control subjects; (B) overall survival (OS) of first-line chemotherapy in EGFR wild-type patients with high-grade patterns and control cohorts; (C) PFS curves of first-line EGFR-tyrosine kinase inhibitor (TKI) treatment in EGFR+ patients with high-grade patterns and control cohorts; (D) OS curves of first-line EGFR-TKI treatment in EGFR+ patients with high-grade patterns and control cohorts.
Figure 4
Figure 4
Response to different therapies in different cohorts. (A) Response to first-line chemotherapy in high-grade patterns and control cohorts. (B) Response to first-generation tyrosine kinase inhibitors (TKIs) in high-grade patterns and control cohorts.
See this image and copyright information in PMC

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