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Comparison of the immunotherapy efficacy between invasive mucinous and non-mucinous adenocarcinoma in advanced lung cancer patients with KRAS mutation: a retrospective study

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Abstract

Invasive mucinous adenocarcinoma (IMA) is a rare variant of adenocarcinoma with unique clinical, radiological, and pathological features, among which KRAS mutation is the most common. However, the differences in the efficacy of immunotherapy between KRAS-positive IMA and invasive non-mucinous adenocarcinoma (INMA) patients remain unclear. Patients with KRAS mutated adenocarcinomas receiving immunotherapy between June 2016 and December 2022 were enrolled. Based on mucin-producing status, the patients were placed into two subgroups: the IMA group and INMA group. Patients with IMA were further classified into two subtypes according to the presence of mucin patterns: pure IMA (≥ 90%) and mixed mucinous/nonmucinous adenocarcinoma (≥ 10% of each histological component). Kaplan–Meier Curves and log-rank tests were used to analyze survival. Cox regression analysis of PFS were used to analyze the independent factors associated with efficacy. Sixty-five advanced adenocarcinoma patients with KRAS mutations received immunotherapy, including 24 patients with IMA and 41 with INMA. The median progression-free survival (PFS) was 7.7 months, whereas the median overall survival (OS) was 24.0 months. Significant difference in PFS could be observed in IMA and INMA (3.5 months vs. 8.9 months; P = 0.047). Patients with pure IMA tended toward prolonger survival in contrast to mixed mucinous/nonmucinous adenocarcinoma in PFS (8.4 months vs. 2.3 months; P = 0.349). The multivariable analysis demonstrated that IMA was an independent risk factor for PFS. In KRAS mutated patients, IMA was associated with poorer PFS after immunotherapy compared with INMA.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to appreciate all patients for their cooperation and participation. In addition, we are thankful to all research staff and co-investigators involved in this study.

Funding

The study was supported by the Medical Scientific Research Foundation of Zhejiang Province (No.2022KY653), and sponsored by Zhejiang provincial program for the Cultivation of High-Level Innovative Health Talents (to Zhengbo Song).

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Author notes

  1. Manyi Xu, Yue Hao, Huan Zhou Contributed equally to this work.

Authors and Affiliations

  1. The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, People’s Republic of China

    Manyi Xu, Yue Hao, Huan Zhou & Jinfei Si

  2. Department of Clinical Trail, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People’s Republic of China

    Manyi Xu, Yue Hao, Huan Zhou, Zheng shi, Jinfei Si & Zhengbo Song

  3. Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People’s Republic of China

    Manyi Xu, Yue Hao, Huan Zhou, Zheng shi, Jinfei Si & Zhengbo Song

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  1. Manyi Xu
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  4. Zheng shi
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Contributions

ZS designed and supervised the research. MX, YH, HZ conducted the follow-up, data collection, and correlative analysis. HZ and ZS provided support in data analysis and use of software. MX, YH provided data analysis. All authors were involved in manuscript preparation and approved the final manuscript.

Corresponding author

Correspondence to Zhengbo Song.

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All authors declare no conflict of interest.

Ethics approval and consent to participate

Approval of the study protocol was obtained from Zhejiang Cancer Hospital Institutional Review Board Committee (approval number: IRB-2022–187). Individual consent for this retrospective analysis was waived.

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Individual consent for analysis was waived.

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Xu, M., Hao, Y., Zhou, H. et al. Comparison of the immunotherapy efficacy between invasive mucinous and non-mucinous adenocarcinoma in advanced lung cancer patients with KRAS mutation: a retrospective study. Med Oncol 40, 198 (2023). https://doi.org/10.1007/s12032-023-02059-w

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  • DOI: https://doi.org/10.1007/s12032-023-02059-w

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