Driver Mutations Determine Survival in Smokers and Never Smokers with Stage IIIB/IV Lung Adenocarcinomas

摘要: BACKGROUND: The authors previously demonstrated that never-smokers with stage IIIB/IV nonsmall cell lung cancer (NSCLC) lived 50% longer than former/current smokers. This observation persisted after adjusting for age, performance status, and sex. In this study, the hypothesized smoking-dependent differences in distribution of driver mutations may explain prognosis between these subgroups. METHODS: In total, 293 382 smokers adenocarcinoma who underwent testing epidermal growth factor receptor (EGFR) v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) rearrangements anaplastic lymphoma kinase (ALK) 2009 2010 were investigated. Clinical outcomes patient characteristics collected. Survival probabilities estimated using Kaplan-Meier method. Group comparison was performed log-rank tests Cox proportional hazards methods. RESULTS: Although overall incidence nearly identical (55% vs 57% current/former smokers; P = .48), there significant groups EGFR (37% 14% < .0001), KRAS (4% 43% ALK (12% 2% .0001). Among smokers, differed significantly by genotype. Patients had poorest survival. Smoking however, no influence on survival within each genotype. CONCLUSIONS: Never-smokers adenocarcinomas not homogeneous subgroups. Each made up individuals whose tumors a unique mutations, which associated different prognoses, irrespective smoking history. Cancer 2012. © 2012 American Society.