EGFR mutation testing in patients with advanced non-small cell lung cancer: a comprehensive evaluation of real-world practice in an East Asian tertiary hospital.
EGFR mutation testing in patients with advanced non-small cell lung cancer: a comprehensive evaluation of real-world practice in an East Asian tertiary hospital.
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DOI：
10.1371/journal.pone.0056011
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Shim YM
中科院分区：
文献类型：
--
作者：
Choi YL;Sun JM;Cho J;Rampal S;Han J;Parasuraman B;Guallar E;Lee G;Lee J;Shim YM
非小细胞肺癌（NSCLC）治疗指南强烈推荐EGFR突变检测。这些建议尤其适用于EGFR突变发生率较高的亚洲人。本研究旨在探讨韩国一家大型综合癌症中心的晚期非小细胞肺癌患者目前的检测实践、检测后勤、EGFR突变类型和EGFR突变的患病率。我们的回顾性队列包括1,503例年龄≥18岁，IIIB/IV期疾病的非小细胞肺癌患者，他们于2007年1月至2010年7月在韩国首尔的三星医疗中心就诊。受过培训的肿瘤科护士审查并从电子病历中提取数据。该队列的平均年龄（SD）为59.6（11.1）岁，62.7%为男性，52.9%为不吸烟者。最常见的非小细胞肺癌组织学类型为腺癌（70.5%）和鳞状细胞癌（18.0%）。总体而言，39.5%的患者接受了EGFR突变检测。2007年1月至2008年7月、2008年8月至2009年9月、2009年10月至2010年7月接受EGFR检测的患者比例分别为23.3%、38.3%和63.5% （P<0.001）。从癌症诊断到接受EGFR检测结果的中位时间为21天。肿瘤医生（57.7%）、肺科医生（31.9%）和胸外科医生（6.6%）最常要求进行EGFR检测。EGFR检测更常见于女性、年轻患者、IV期疾病、非吸烟者和腺癌组织学。在586例成功检测EGFR突变的病例中，209例（35.7%）呈阳性，其中118例外显子19缺失，62例L858R突变。EGFR突变阳性的患者更有可能是女性、不吸烟、不喝酒和患腺癌。在韩国的一家大型癌症中心，从2007年到2010年，EGFR检测的比例有所增加。EGFR突变阳性病例的高频率保证了对亚洲非小细胞肺癌患者进行广泛检测的必要性。
Guidelines for management of non-small cell lung cancer (NSCLC) strongly recommend EGFR mutation testing. These recommendations are particularly relevant in Asians that have higher EGFR mutation prevalence. This study aims to explore current testing practices, logistics of testing, types of EGFR mutation, and prevalence of EGFR mutations in patients with advanced NSCLC in a large comprehensive cancer center in Korea. Our retrospective cohort included 1,503 NSCLC patients aged ≥18 years, with stage IIIB/IV disease, who attended the Samsung Medical Center in Seoul, Korea, from January 2007 through July 2010. Trained oncology nurses reviewed and abstracted data from electronic medical records. This cohort had a mean age (SD) of 59.6 (11.1) years, 62.7% were males, and 52.9% never-smokers. The most common NSCLC histological types were adenocarcinoma (70.5%) and squamous cell carcinoma (18.0%). Overall, 39.5% of patients were tested for EGFR mutations. The proportion of patients undergoing EGFR testing during January 2007 through July 2008, August 2008 through September 2009, and October 2009 through July 2010 were 23.3%, 38.3%, and 63.5%, respectively (P<0.001). The median time elapsed between cancer diagnoses and receiving EGFR testing results was 21 days. EGFR testing was most frequently ordered by oncologists (57.7%), pulmonologists (31.9%), and thoracic surgeons (6.6%). EGFR testing was more commonly requested for women, younger patients, stage IV disease, non-smokers, and adenocarcinoma histology. Of 586 cases successfully tested for EGFR mutations, 209 (35.7%) were positive, including 118 cases with exon 19 deletions and 62 with L858R mutations. EGFR mutation positive patients were more likely to be female, never-smokers, never-drinkers and to have adenocarcinoma. In a large cancer center in Korea, the proportion of EGFR testing increased from 2007 through 2010. The high frequency of EGFR mutation positive cases warrants the need for generalized testing in Asian NSCLC patients.
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