Abstract
BackgroundVascular mimicry (VM) was associated with the prognosis of cancers. The aim of the study was to explore the association between VM and anticancer therapy response in patients with lung adenocarcinoma.MethodsThis was a single-center retrospective study of patients with lung adenocarcinoma between March 1st, 2013, to April 1st, 2019, at the Second People’s Hospital of Taizhou City. All included patients were divided into the VM and no-VM groups according to whether VM was observed or not in the specimen. Vessels with positive PAS and negative CD34 staining were confirmed as VM. The main outcome was progression-free survival (PFS).ResultsSixty-six (50.4%) patients were male. Eighty-one patients received chemotherapy as the first-line treatment, and 50 patients received TKIs. Forty-five (34.4%) patients were confirmed with VM. There was no difference regarding the first-line treatment between the VM and no-VM groups (P = 0.285). The 86 patients without VM had a median PFS of 279 (range, 90–1095) days, and 45 patients with VM had a median PFS of 167 (range, 90–369) days (P < 0.001). T stage (hazard ratio (HR) = 1.37, 95% confidence interval (CI): 1.10–1.71), N stage (HR = 1.43, 95%CI: 1.09–1.86), M stage (HR = 2.85, 95%CI: 1.76–4.61), differentiation (HR = 1.85, 95%CI: 1.29–2.65), therapy (HR = 0.32, 95%CI: 0.21–0.49), VM (HR = 2.12, 95%CI: 1.33–3.37), and ECOG (HR = 1.41, 95%CI: 1.09–1.84) were independently associated with PFS.ConclusionThe benefits of first-line TKIs for NSCLC with EGFR mutation are possibly better than those of platinum-based regimens in patients without VM, but there is no difference in the benefit of chemotherapy or target therapy for VM-positive NSCLC harboring EGFR mutations.
Highlights
Vascular mimicry (VM) was associated with the prognosis of cancers
In advanced non-small cell lung cancer (NSCLC) harboring EGFRsensitive mutations, it has become a consensus that tyrosine kinase inhibitors (TKIs) should be preferred for first-line treatment, but the effective response rates to first-generation TKIs such as gefitinib and erlotinib and the next-generation drugs such as afatinib and oxetinib are less than 80% [7, 8]
Characteristics of the patients A total of 979 patients were newly diagnosed with lung cancer during the study period, of whom 591 patients were pathologically confirmed with NSCLC, and 395 patients were confirmed with lung adenocarcinoma of stage IIIB-IV
Summary
Vascular mimicry (VM) was associated with the prognosis of cancers. The aim of the study was to explore the association between VM and anticancer therapy response in patients with lung adenocarcinoma. In the past twenty years, with the discovery and better understanding of mutations in the epithelial growth factor receptor (EGFR) as a cancer-driving event and the use of tyrosine kinase inhibitors (TKIs), patients with lung cancer harboring EGFR-sensitizing mutation have benefited from prolonged progression-free survival (PFS) compared with patients who received conventional platinum-based chemotherapy only [4]. It is considered that different mechanisms are underlying the response to chemotherapy and TKIs in patients with non-small cell lung cancer (NSCLC) harboring EGFR mutation, but which subpopulation will respond better to chemotherapy or TKIs is still unknown. In advanced NSCLC harboring EGFRsensitive mutations, it has become a consensus that TKIs should be preferred for first-line treatment, but the effective response rates to first-generation TKIs such as gefitinib and erlotinib and the next-generation drugs such as afatinib and oxetinib are less than 80% [7, 8]. How to predict whether NSCLC patients will respond effectively to first-line TKIs before starting treatment has become a key problem to be solved urgently
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