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Primary Tumor Resection for Stage IV Non-small-cell Lung Cancer Without Progression After First-Line Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor Treatment: A Retrospective Case–Control Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 09 April 2022

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Abstract

Background

In studies of stage IV epidermal growth factor receptor (EGFR)-mutant nonsmall-cell lung cancer (NSCLC), <10% of patients underwent surgery; thus, the effect of surgery in these patients remains unclear. We investigated whether primary lung tumor resection could improve the survival of patients with stage IV EGFR-mutant NSCLC without progression after first-line EGFR-tyrosine kinase inhibitor (EGFR-TKI) treatment.

Methods

This retrospective case–control study included patients treated with first-line EGFR-TKIs without progression on follow-up imaging. Patients in the surgery group (n = 56) underwent primary tumor resection, followed by TKI maintenance therapy. Patients in the control group (n = 224; matched for age, metastatic status, and Eastern Cooperative Oncology Group performance status) received only TKI maintenance therapy. Local ablative therapy for distant metastasis was allowed in both groups. The primary endpoint was progression-free survival. The secondary endpoints were overall survival, failure patterns, and complications/adverse events.

Results

The median time from TKI treatment to surgery was 5.1 months. For the surgery and control groups, the median follow-up periods were 34.0 and 38.5 months, respectively, with a median (95% confidence interval) progression-free survival of 29.6 (18.9–40.3) and 13.0 (11.8–14.2) months, respectively (P < 0.001). Progression occurred in 29/56 (51.8%) and 207/224 (92.4%) patients, respectively. The median overall survival in the surgery group was not reached. The rate of surgical complications of grade ≥2 was 12.5%; complications were treated conservatively.

Conclusions

Primary tumor resection is feasible for patients with EGFR-mutant nonprogressed NSCLC during first-line EGFR-TKI treatment and may improve survival better than maintenance EGFR-TKI therapy alone.

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Acknowledgments

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Author notes

  1. Shuenn-Wen Kuo and Pei-Hsing Chen contributed equally as co-first authors.

Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City 100, Taiwan

    Shuenn-Wen Kuo MD, Ke-Cheng Chen MD, Mong-Wei Lin MD, Hsao-Hsun Hsu MD & Jin-Shing Chen MD

  2. Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan

    Pei-Hsing Chen MD

  3. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City 100, Taiwan

    Tzu-Pin Lu Ph.D

  4. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City 100, Taiwan

    Tzu-Pin Lu Ph.D

  5. Department of Traumatology, National Taiwan University Hospital, Taipei City 100, Taiwan

    Hsien-Chi Liao MD

  6. Department of Surgery, Taipei City Hospital, Taipei City, 115, Taiwan

    Kuan-Chuan Tsou MD

  7. Department of Surgical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei City 106, Taiwan

    Tung-Ming Tsai MD & Jin-Shing Chen MD

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  1. Shuenn-Wen Kuo MD
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Correspondence to Jin-Shing Chen MD.

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Kuo, SW., Chen, PH., Lu, TP. et al. Primary Tumor Resection for Stage IV Non-small-cell Lung Cancer Without Progression After First-Line Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor Treatment: A Retrospective Case–Control Study. Ann Surg Oncol 29, 4873–4884 (2022). https://doi.org/10.1245/s10434-022-11483-7

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