The Current Consensus on Salvage Surgery after Targeted Therapy for Advanced EGFR-Mutant Non-Small Cell Lung Cancer.

IF 1 Q4 Medicine
Yu-Wei Liu, Po-Chih Chang, Jadzia Tin-Tsen Chou, Shah-Hwa Chou
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引用次数: 0

Abstract

Salvage surgery is an emerging option for carefully selected patients with advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) whose disease remains controlled on tyrosine kinase inhibitor (TKI) therapy. Fourteen retrospective series report median progression-free survival (PFS) of 14-52 months and overall survival (OS) often exceeding 3 years, suggesting better disease control than continued TKI therapy alone. Although PFS generally improves, some cohorts show no OS advantage, probably because effective post-progression treatments dilute survival differences. Non-surgical local consolidative therapies remain essential for oligometastatic disease; nevertheless, resection yields intact specimens for comprehensive pathologic and molecular analysis. Access to tissue permits earlier identification of resistance mechanisms-most commonly the T790M mutation-more accurate prognostication, and more precise systemic-therapy selection. Comprehensive sampling can also identify histologic transformation and compound mutations that precede radiologic progression. Adverse prognostic factors include older age, high preoperative carcinoembryonic antigen levels, advanced pathological T stage, programmed death-ligand 1 ≥1%, and spread through air spaces. Salvage surgery is feasible and effective in carefully selected patients, especially those with oligoresidual disease and favorable tumor biology. Patient selection should integrate performance status, anatomic extent, histopathology, and genomic profile through multidisciplinary discussions. Despite regional differences (e.g., higher EGFR-mutation prevalence and wider adoption of minimally invasive approaches in East Asia) oncologic outcomes are comparable when selection criteria are applied consistently. Prospective trials are warranted to validate these retrospective observations, refine selection algorithms, establish optimal timing, and clarify how surgery can best be integrated with next-generation targeted agents and immunotherapies.

目前对晚期egfr突变非小细胞肺癌靶向治疗后抢救手术的共识。
对于经过精心挑选的晚期表皮生长因子受体(EGFR)突变的非小细胞肺癌(NSCLC)患者来说,挽救性手术是一种新兴的选择,这些患者的疾病仍然通过酪氨酸激酶抑制剂(TKI)治疗得到控制。14个回顾性系列报告中位无进展生存期(PFS)为14-52个月,总生存期(OS)通常超过3年,表明比继续TKI治疗更好的疾病控制。虽然PFS普遍改善,但一些队列没有显示OS优势,可能是因为有效的进展后治疗淡化了生存差异。非手术的局部巩固治疗对于低转移性疾病仍然是必要的;然而,切除产生完整的标本进行全面的病理和分子分析。进入组织可以更早地识别耐药机制——最常见的是T790M突变——更准确的预测,更精确的系统治疗选择。全面的采样也可以识别在放射学进展之前的组织学转化和复合突变。不良预后因素包括年龄较大,术前癌胚抗原水平高,病理性T期晚期,程序性死亡-配体1≥1%,并通过空气空间扩散。在精心挑选的患者中,特别是那些患有少量残留疾病和有利的肿瘤生物学的患者,保留手术是可行和有效的。患者的选择应通过多学科讨论综合性能状态、解剖程度、组织病理学和基因组图谱。尽管存在地区差异(例如,东亚地区egfr突变发生率较高,更广泛地采用微创方法),但当选择标准一致时,肿瘤结果具有可比性。前瞻性试验有必要验证这些回顾性观察结果,完善选择算法,建立最佳时机,并阐明手术如何最好地与下一代靶向药物和免疫疗法相结合。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Chest Surgery
Journal of Chest Surgery Medicine-Surgery
CiteScore
0.80
自引率
0.00%
发文量
76
审稿时长
7 weeks
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