術前liquid biopsyを用いたゲノム・RNA発現解析による肺癌術後の個別化医療の探索

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We enrolled patients with lung cancer who underwent surgery without preoperative chemotherapy at the Kanazawa University Hospital.We extracted cfDNA from the plasma within 7 days before surgery using Qiagen and measured its concentration using Qubit High sensitivity. CfDNA from patients with EGFR-mutated NSCLC was analyzed using Digital Droplet PCR.We retrospectively collected patient characteristics including EGFR mutation status, DFS, and OS. Written informed consent was obtained from all the patients.A total of 285 patients were enrolled in this study. The median age was 71 years, and 62% of the patients were male. EGFR mutations were present in 42% of patients with adenocarcinoma. The EGFR-positive cases were predominantly female, and 80% were pStage 1. No significant correlation between cfDNA concentration and OS in pStage 0 to 3. We analyzed common EGFR mutations and detected L858R mutations in 16 of 56 patients and deletion 19 in 7 of 32 patients. CfDNA-positive patients had a significantly shorter DFS than cfDNA-negative patients.There was no correlation between preoperative cfDNA concentration and prognosis in our study, probably because cfDNA other than that derived from the tumor was also detected. In our study, EGFR-mutated surgical patients at stages II and III tended to have shorter DFS than EGFR wild-type patients. Postoperative osimertinib administration may be a better indication for ctDNA-positive cases.