Outcomes of Early-Stage Lung Cancer with Rare Mutations
Author Information
Author(s): Nadia Ghazali, Jamie Feng, Katrina Hueniken, Khaleeq Khan, Karmugi Balaratnam, Thomas K. Waddell, Kazuhiro Yasufuku, Andrew Pierre, Laura Donahoe, Elliot Wakeam, Marcelo Cypel, Jonathan Yeung, Shaf Keshavjee, Marc de Perrot, Natasha B. Leighl, Geoffrey Liu, Penelope A. Bradbury, Adrian Sacher, Lawson Eng, Tracy Stockley, Ming Sound Tsao, Frances A. Shepherd
Primary Institution: University Health Network (UHN), Toronto, ON, Canada
Hypothesis
This study aims to assess relapse-free survival (RFS) and overall survival (OS) in patients with resected early-stage NSCLC with rare targetable driver mutations.
Conclusion
While RFS was poorer for most mutations compared to KRAS G12C, OS generally was better, suggesting a potential role for postoperative targeted therapies.
Supporting Evidence
- Five-year survival probabilities were 76% for stage I, 60% for stage II, and 58% for stage III.
- RFS was significantly shorter in stage III compared to stage I.
- Patients with ROS1 fusion had the worst RFS compared to KRAS G12C mutation.
- TP53 co-mutation was associated with significantly worse OS.
Takeaway
This study looked at patients with early-stage lung cancer who had rare mutations. It found that most of these mutations made it more likely for the cancer to come back, but overall survival was better than for a common mutation.
Methodology
This was a retrospective single-center study identifying stage I–III NSCLC patients with rare targetable mutations who underwent curative surgery.
Potential Biases
The rarity of these molecular alterations limited the statistical power needed to conduct more in-depth multivariable comparisons of some of the mutation subgroups.
Limitations
This was a retrospective single-institution study, which may limit the generalizability of the results; more research is needed to determine whether the same associations persist in different clinical contexts.
Participant Demographics
{"age":{"median":66.5,"range":"40.0-89.4"},"sex":{"female":139,"male":86},"smoking_status":{"current_or_former_smoker":141,"never_smoker":65},"stage_at_diagnosis":{"stage_I":141,"stage_II":43,"stage_III":41},"histology":{"adenocarcinoma":208,"mixed":5,"other":7},"surgery_type":{"lobectomy":174,"wedge_resection":33,"segmentectomy":8,"pneumonectomy":3},"chemotherapy":{"perioperative_chemotherapy":70,"median_cycles":4},"TP53_status":{"wild_type":142,"mutant":75}}
Statistical Information
P-Value
{"RFS":"p=0.019","OS":"p=0.008"}
Confidence Interval
{"RFS":"95% CI: 1.18, 6.20","OS":"95% CI: 1.26, 4.40"}
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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