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Original research
Prognostic factors for survival in unresectable stage III EGFR mutation-positive lung adenocarcinoma: impact of pre-CCRT PET-CT
  1. Wei-Chun Lin1,
  2. Wan-Ming Chen2,3,
  3. Ben-Chang Shia2,4,
  4. Szu-Yuan Wu2,3,4,5,6,7,8,9,10
  1. 1 Division of Chest Medicine, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
  2. 2 Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
  3. 3 Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
  4. 4 Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
  5. 5 Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
  6. 6 Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
  7. 7 Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
  8. 8 Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
  9. 9 Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  10. 10 Department of Management, College of Management, Fo Guang University, Yilan, Taiwan
  1. Correspondence to Dr Szu-Yuan Wu, Department of Radiation Oncology, Taipei Medical University, Taipei, Taiwan; szuyuanwu5399{at}gmail.com

Abstract

Purpose To assess the survival impact of pre-concurrent chemoradiotherapy (CCRT) staging with positron emission tomography-CT (PET-CT) in patients with unresectable epidermal growth factor receptor (EGFR) mutation-positive adenocarcinoma.

Methods Patients with unresectable stage IIIA–IIIC EGFR mutation-positive adenocarcinoma undergoing definitive CCRT were divided into two groups: those who received PET-CT staging prior to CCRT and those with other staging methods. Survival outcomes were compared after propensity score matching.

Results Analysis of 11 856 patients (5928 in each group) showed that PET-CT staging was associated with improved survival (adjusted HR of all-cause mortality: 0.74, 95% CI 0.71 to 0.79). Other prognostic factors included male sex, age group, clinical stage, adjuvant treatment, smoking status, Charlson Comorbidity Index score and treatment setting.

Conclusion Pre-CCRT staging with PET-CT in patients with unresectable EGFR mutation-positive adenocarcinoma of clinical stage IIIA–IIIC was associated with enhanced survival. Independent prognostic factors were also identified.

  • Lung Cancer

Data availability statement

Data may be obtained from a third party and are not publicly available. Data analysed during the study were provided by a third party. Requests for data should be directed to the provider indicated in the Acknowledgments section. We used data from the National Health Insurance Research Database and Taiwan Cancer Registry database. The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. The data used in this study cannot be made available in the manuscript, the supplemental files or in a public repository due to the Personal Information Protection Act executed by Taiwan’s government, starting in 2012. Requests for data can be sent as a formal proposal to obtain approval from the ethics review committee of the appropriate governmental department in Taiwan. Specifically, links regarding contact info for which data requests may be sent to are as follows: NHIRD Data Subsets and NHIS Data Access. The data sets supporting the study conclusions are included in the manuscript.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data analysed during the study were provided by a third party. Requests for data should be directed to the provider indicated in the Acknowledgments section. We used data from the National Health Insurance Research Database and Taiwan Cancer Registry database. The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. The data used in this study cannot be made available in the manuscript, the supplemental files or in a public repository due to the Personal Information Protection Act executed by Taiwan’s government, starting in 2012. Requests for data can be sent as a formal proposal to obtain approval from the ethics review committee of the appropriate governmental department in Taiwan. Specifically, links regarding contact info for which data requests may be sent to are as follows: NHIRD Data Subsets and NHIS Data Access. The data sets supporting the study conclusions are included in the manuscript.

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Footnotes

  • W-CL and W-MC contributed equally.

  • Contributors Conception and design: W-CL, W-MC and S-YW. Collection and assembly of data: W-CL, W-MC, B-CS and S-YW. Data Analysis and interpretation: W-MC, W-CL and S-YW. Administrative support: S-YW. Manuscript writing: W-MC and W-CL. Final approval of manuscript: all authors. Guarantors: W-CL, W-MC and S-YW.

  • Funding Financial support for this research was provided by the Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, under funding numbers: 10908, 10909, 11001, 11002, 11003, 11006 and 11013, in support of S-YW's work.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.