Purpose: We aim to observe the potential survival benefits of driver gene-guided targeted therapy in advanced non-small cell lung cancer (NSCLC) patients compared to non-targeted therapy. Additionally, the study aims to assess whether Next-generation sequencing technology (NGS)-guided targeted therapy can provide survival advantages for advanced NSCLC patients compared to conventional Epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK) gene detection.
Methods: Clinical data, genetic testing results, and treatment information of 1663 advanced lung cancer patients diagnosed by pathology from January 2013 to June 2019 in Jiangsu University Affiliated Lianyungang Hospital were collected. Propensity score matching survival analysis was used to evaluate the differences in overall survival(OS) between groups.
Results: In the unadjusted survival curve, targeted therapy patients had significantly longer median OS than non-targeted therapy patients (28.3 months vs 15.4 months, Hazard ratio (HR) = 0.5426, 95% confidence interval (CI) 0.4768– 0.6176, P < 0.0001); the conclusion was the same after propensity score matching analysis, with targeted therapy group patients having significantly prolonged OS median (27.5 months vs 14.8 months, HR = 0.5572, 95% CI 0.4796– 0.6474, P < 0.0001). In the unadjusted survival curve, the NGS group had a significantly prolonged median OS compared to the conventional gene detection group (23.4 months vs 21.2 months, HR = 1.243, 95% CI = 1.017– 1.519, P = 0.0495). However, after propensity score matching analysis, no statistically significant difference existed in the median OS between the two patient groups (23.1 months vs 21.5 months, HR = 1.288, 95% CI = 0.9557– 1.735, P = 0.0926). Further analysis demonstrated no advantage in the five-, three-, and two-year survival rates of the NGS group compared to conventional gene detection group patients. However, the one-year survival rate of the NGS group was significantly increased (83.2% vs 68.1%, HR = 0.4890, 95% CI = 0.3170– 0.7544, P = 0.0015).
Conclusion: Driver gene-guided targeted precision therapy significantly prolonged the median OS of advanced NSCLC patients compared to non-targeted therapy. NGS detection did not improve the median OS of advanced NSCLC patients compared to conventional EGFR/ALK gene detection but increased the one-year survival rate of patients.

Keywords: non-small cell lung cancer, NGS, EGFR, ALK, prognosis


中文翻译：

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NGS检测或常规检测指导精准靶向治疗的晚期非小细胞肺癌患者的预后

目的：我们旨在观察与非靶向治疗相比，驱动基因引导的靶向治疗对晚期非小细胞肺癌（NSCLC）患者的潜在生存获益。此外，该研究旨在评估与传统表皮生长因子受体（ EGFR）/间变性淋巴瘤激酶（ALK ）基因检测相比，下一代测序技术（NGS）引导的靶向治疗是否能为晚期NSCLC患者提供生存优势。
方法：收集2013年1月至2019年6月江苏大学附属连云港医院1663例经病理诊断的晚期肺癌患者的临床资料、基因检测结果及治疗信息。使用倾向评分匹配生存分析来评估组间总生存（OS）的差异。
结果：在未调整的生存曲线中，靶向治疗患者的中位 OS 明显长于非靶向治疗患者（28.3 个月 vs 15.4 个月，风险比（HR）= 0.5426，95% 置信区间（CI）0.4768–0.6176，P < 0.0001); 倾向评分匹配分析后结论相同，靶向治疗组患者中位OS显着延长（27.5个月vs 14.8个月，HR = 0.5572，95% CI 0.4796–0.6474，P < 0.0001）。在未调整的生存曲线中，与传统基因检测组相比，NGS组的中位OS显着延长（23.4个月vs 21.2个月，HR = 1.243，95% CI = 1.017–1.519，P = 0.0495）。然而，倾向评分匹配分析后，两组患者的中位 OS 没有统计学差异（23.1 个月 vs 21.5 个月，HR = 1.288，95% CI = 0.9557–1.735，P = 0.0926）。进一步分析显示，与传统基因检测组患者相比，NGS组患者的五年、三年和两年生存率没有优势。然而，NGS组的一年生存率显着提高（83.2% vs 68.1%，HR = 0.4890，95% CI = 0.3170–0.7544，P = 0.0015）。
结论：与非靶向治疗相比，驱动基因引导的靶向精准治疗显着延长了晚期 NSCLC 患者的中位 OS。与传统EGFR/ALK基因检测相比，NGS检测并未提高晚期NSCLC患者的中位OS，但提高了患者的一年生存率。

关键词:非小细胞肺癌, NGS, EGFR , ALK , 预后