tbuckley/cabot-search huggingface dataset:
Phase I trial of pazopanib in combination with irinotecan and temozolomide (PAZIT) for children and young adults with advanced sarcoma.
Authors: Kieuhoa T. Vo, Jennifer G. Michlitsch, Avanthi T. Shah, Joel M. Reid, Sarah A. Burhow, Eloise M. Graham, Fabienne Hollinger, Matthew A. Zapala, Janel Long-Boyle, Mi-Ok Kim, Katherine K. Matthay, Steven G. DuBois
Journal: Journal of Clinical Oncology (2020)

10526 Background: Pro-angiogenic factors may represent therapeutic targets in sarcoma. Preclinical studies have demonstrated a potential additive or synergistic interaction between anti-angiogenic agents and chemotherapy. The purpose of this study was to determine the maximum tolerated dose (MTD), toxicities, pharmacokinetic (PK) and pharmacodynamics (PD) effects of PAZIT in patients with advanced sarcoma. Methods: Patients 6-30 years of age with relapsed/refractory sarcomas were eligible. In the initial dose escalation plan (A), patients received pazopanib PO (225-450 mg/m 2 /dose) on Days 1-21 of 21-day cycles. Pazopanib was combined with fixed doses of irinotecan (IV 50 or PO 90 mg/m 2 /dose) and temozolomide PO 100 mg/m 2 /dose on Days 1-5. Due to DLTs, an amendment was made to the dose escalation plan (B) and patients received fixed doses of pazopanib PO (225 mg/m 2 /dose) on Days 1-21 of 21-day cycles and reduced irinotecan doses (IV 25-37.5 or PO 45-67.5 mg/m 2 /dose) and temozolomide PO 100 mg/m 2 /dose on Days 1-5. Oral cephalosporin diarrhea prophylaxis was required. Dose escalation followed a 3+3 design. Correlative studies included PK (pazopanib, irinotecan) and PD (angiogenic factors, ctDNA) effects. Results: Sixteen patients were treated (median age 16 years, range 7-21). The dose levels in the table were evaluated. First cycle DLTs occurred at all dose levels (Table) and included diarrhea, pancreatitis, colitis, neutropenia, hypertension, deep vein thrombosis, and ALT increase. Due to excessive toxicity, an MTD could not be established. One patient with osteosarcoma had a partial response. Four patients had prolonged stable disease &gt; 4 cycles, including 2 patients with Ewing sarcoma (5 and 6 cycles), rhabdomyosarcoma (9 cycles), and desmoplastic small round cell tumor (6 cycles). Mean±SD plasma exposures to pazopanib, irinotecan, and SN-38 in patients treated on dose level 1B (n = 4) on Day 4 were 601±83, 1.4±0.2 and 0.1±0.04 ug/mL*hr, respectively. Analyses of correlative studies are ongoing. Conclusions: Combination PAZIT therapy is not tolerable as evaluated at these doses/schedules. This study provides important toxicity data to inform future clinical trials using combination anti-angiogenic strategies in sarcoma. Clinical trial information: NCT03139331. [Table: see text]
Clinical efficacy and safety of doxazosin combined with desmopressin in treatment of nocturia in patients with benign prostatic hyperplasia
Authors: Jianlong Wang, Yaoguang Zhang, Ming Liu, Ben Wan
Journal: BMJ (2016)

Thirty six patients aged 50-70 years with benign prostatic hyperplasia (BPH) received doxazosin and desmopressin treatment for 4 weeks. After treatment the International Prostate Symptom Scores (IPSS)and Quality of Life (QoL) scores of patients were significantly improved (17.4±2.5 vs. 11.8±1.1 and 3.9±0.6 vs. 1.8±1.3, respectively; both P<0.01). The nocturia frequency was decreased from 4.6±1.5 to 2.1±1.6 (P<0.01); nocturnal urine output from (564±73) to (348±45) ml (P<0.05); the hours of undisturbed sleep increased from (88.6±17.5)min to (146.2±12.8)min (P<0.05). There were no significant differences in serum levels of sodium, potassium and chlorine, and osmoticpressure before and after treatment. The results indicate that doxazosin combined with desmopressin is safe and effective for treatment of nocturia in patients with BPH.


Key words: 
Deamino arginine vasopressin; Nocturia; Prostatic hyperplasia
Effects of clinical application of radiofrequency ablation in uterine myomas
Authors: 曹树军
Journal: BMJ (2006)

目的 探讨射频消融术治疗子宫肌瘤的临床价值.方法选择自愿接受射频消融术治疗子宫肌瘤的患者192例,在B超监视和引导下将射频治疗刀经阴道宫颈置入病灶进行射频消融治疗,于治疗后1、3、6、12、24个月随访.结果射频消融治疗后子宫及其肌瘤体积呈进行性缩小,治疗后6个月、12个月和24个月肌瘤体积分别缩小74.6%、78.8%和81.5%,子宫体积分别缩小48.7%、51.9%和53.1%; 88.7%(102/115)的患者术后月经恢复正常,贫血全部得到纠正;原有痛经消失的有50.9%(26/51).总有效率为97.9%(188/192),治愈率为64.0%(123/192).对黏膜下肌瘤射频消融治疗效果最佳,有效率达100.0%(67/67),治愈率达85.1%(57/67).肌瘤大小、生长类型和变性率是影响疗效的主要因素.结论射频消融术毁损肌瘤组织,使瘤体和子宫明显缩小,显著改善临床症状。
When to include clinical study reports and regulatory documents in systematic reviews
Authors: Jeferson Tom, Doshi Peter, Boutron Isabelle, Golder Su, Heneghan Carl, Hodkinson Alex, Jones Mark, Lefebvre Carol, Stewart Lesley A, 武泽昊, 杨瑀譞, 彭晓霞
Journal: BMJ (2020)

报告偏倚是影响系统综述真实性和可靠性的主要威胁。本文总结了获取临床研究报告和其他监管文件（监管数据）来应对报告偏倚的基本原理，以及有助于决定是否将监管数据纳入系统综述的决定因素。同时介绍了监管数据获取的来源和现状，并针对当前系统综述的作者在考虑将监管数据纳入系统综述时的做法进行的调查进行了总结。本文没有解决如何获得和提取监管数据的问题。应鼓励像Cochrane这样的组织机构和利益相关者使用临床研究报告中的数据作为药品干预评价的重要数据来源，尤其是干预措施非常重要，且报告偏倚发生风险较大时。
Development of basic medical service items in Shanghai community health service system
Authors: Zhaohui Du, Huimin Dai, Fang Zhang
Journal: BMJ (2015)

Objective
To define basic medical service items in Shanghai community health centers.


Methods
Two rounds of Delphi expert consultation were carried out with 36 experts specialized in general practice, general practitioner training, internal practice, public health and health management, then the scope of medical service system was set up based on experts' opinions.


Results
The newly-defined system consisted of three first-grade items: outpatient medical service, hospital medical service and medical service for home beds and temporary home visits. The first-grade items contained 22 second-grade items and the second-grade items consisted of 26 detailed items, including 17 baseline items, 8 optional items and 1 restrained item. In two rounds of Delphi consultation the activity coefficient of experts was all 100%, authority coefficients of experts was 0.825, and harmonious coefficient of the importance of the evaluation was 0.361 and 0.488 (all P<0.01), respectively.


Conclusion
The preliminarily developed system of basic medical service items in Shanghai community health service can provide a reference frame for government policy-making.


Key words: 
Community health services; Delphi technique; Basic medical service items
Mammography utilization among women with a negative circulating tumor DNA-based early cancer detection test.
Authors: Claire Jones, Alex Parker, Andrew Warren, Erin A Vanenkevort, Mudit Gupta, Braxton Lagerman, Ashley M Honushefsky, Ariella Cohain, Rosemary Leeming, Anne Marie O'Broin-Lennon, Adam H Buchanan
Journal: Journal of Clinical Oncology (2020)

1563 Background: Blood-based tests may enable minimally invasive detection of multiple cancer types. One such test, CancerSEEK, employs ctDNA and protein biomarkers for this purpose. Test performance has been evaluated in women without a history of cancer in an ongoing prospective study called DETECT-A. The introduction of such blood tests holds promise, and their future utility lies in augmenting, not displacing, standard-of-care (SOC) cancer screening. One important safety concern is that a negative test result could provide false reassurance that discourages adherence to SOC cancer screening. To investigate this possibility, we studied delivery of mammography to DETECT-A participants before and after receipt of a negative CancerSEEK result. Methods: DETECT-A screened 10,000 women aged 65-75 using CancerSEEK. Participants completed a survey about cancer screening at enrollment and at one-year post-enrollment. We analyzed only those participants who had received a negative CancerSEEK result, were insured by Geisinger Health Plan (GHP), and had completed both surveys. GHP claims data were used to identify mammograms performed within one year prior-to and post-enrollment. Overall utilization was determined by combining claims and survey data at enrollment and one-year post-enrollment. In addition to comparing SOC screening rates pre- versus post-testing, we evaluated the impact of primary care physician (PCP) type (Geisinger versus any other institution), as screening reminder mechanisms differ between institutions. Results: Of the 2,241 participants who met analysis criteria, 73.6% (n = 1,650) had a mammogram in the year before enrollment while a significantly great number (79.3%, n = 1,777) did so during the one-year follow-up (χ 2 (1) = 59.05, p &lt; 0.001). At enrollment, there were 591 participants who had not had a mammogram completed in the previous year, but 404 (68.4%) of them did have a mammogram during the one-year follow-up. The rate of change in mammography utilization did not differ between those who had a Geisinger versus a non-Geisinger PCP (χ 2 (2) = 1.83, p = 0.40). Conclusions: Participants in a study using a novel blood test for earlier cancer detection had a significantly higher rate of annual mammography after study enrollment and testing. These results indicate that introduction of a minimally invasive ctDNA and protein biomarker-based cancer screening test may engender greater, not lesser, utilization of SOC cancer screening. Further study is required to understand the root causes of increased utilization in this context.
Assessing the impact of antiemetic guideline compliance on prevention of chemotherapy-induced nausea and vomiting (CINV): Results of the Nausea/Emesis Registry in Oncology (NERO).
Authors: Matti S. Aapro, Marika Chrápavá, Razvan-Ovidiu D. Curca, Laurentia Gales, Alexandru Calim Grigorescu, Bára Karlínová, Renata Kellnerová, Edgar Petru, Adam Pluzanski, Maryna Rubach, Guenther G. Steger, Petra Tesarova, Nicolay Yordanov, Anna Walaszkowska-Czyz
Journal: Journal of Clinical Oncology (2020)

12083 Background: Evidence-based antiemetic guidelines offer predominantly consistent recommendations for CINV prophylaxis. However, studies and surveys suggest that adherence to these recommendations is suboptimal. We explored potential inconsistencies between clinical practice and guideline-recommended treatment with a registry evaluating the effect of guideline-consistent CINV prophylaxis (GCCP) on patient outcomes. Methods: This was a prospective, non-interventional, observational, multicenter study designed to assess overall (0-120 h) complete response (CR: no emesis/no rescue use) rates in patients who received GCCP or guideline inconsistent CINV prophylaxis (GICP) using diaries for 5 days following chemotherapy. Cycle 1 results are presented in patients who received either 1) anthracycline/cyclosphosphamide (AC) highly emetogenic chemotherapy (HEC), non-AC HEC or carboplatin, with GCCP for all these groups consisting of prophylaxis with an NK 1 receptor antagonist (RA), 5-HT 3 RA, and dexamethasone (DEX) prior to chemotherapy or 2) moderately emetogenic chemotherapy (MEC), with GCCP consisting of a 5-HT 3 RA and DEX prior to chemotherapy as per MASCC 2016 guidelines. CR rates for cohorts deemed to be GCCP and GICP were compared using a chi-square test. Results: A total of 1,089 patients were part of the cycle 1 efficacy evaluation. Overall GCCP was 23% for all patients. CR rates were significantly higher in patients receiving GCCP versus GICP (Table). Conclusions: Consistent with prior studies, GCCP was very low. The primary endpoint of the study was achieved as there was a significant benefit of almost 10% improved prevention of CINV when administering GCCP. As per MASCC/ESMO guidelines such an absolute difference should be practice changing. Comprehensive multifaceted strategies are needed to achieve better adherence to antiemetic guidelines. [Table: see text]
苦参素葡萄糖注射液治疗慢性荨麻疹42例
Authors: 江明, 徐素平, 孙卫国
Journal: BMJ (2011)

2009年2月至2010年10月,治疗82例慢性荨麻疹患者,观察其疗效及其对血清IgE水平的影响.一、对象与方法1.临床资料:82例均为门诊患者,临床表现符合荨麻疹诊断标准[1].不在哺乳期或妊娠期内,能遵医嘱按时用药者纳入本观察对象,按就诊顺序分为两组,治疗组42例,男18例,女24例,年龄15～58岁,病程2个月～5年;对照组40例,男17例,女23例,年龄17 ～ 56岁,病程2个月～4年.两组患者年龄、性别、病程差异无统计学意义,具有可比性. 关键词：荨麻疹
Youth and Young Adult Use of Pod-Based Electronic Cigarettes From 2015 to 2019
Authors: Stella Juhyun Lee, Vaughan W. Rees, Noam Yossefy, Karen M. Emmons, Andy S. L. Tan
Journal: JAMA Pediatrics (2020)

<h3>Importance</h3> The use of electronic cigarettes (e-cigarettes) has rapidly increased among youth and young adults, but knowledge gaps exist on the potential health effects of using recently introduced pod-based e-cigarettes. <h3>Objective</h3> To conduct a systematic review of recent peer-reviewed scientific literature on pod-based e-cigarettes. <h3>Evidence Review</h3> A search of online databases, including PubMed, Web of Science, Embase, and EBSCO HOST, was conducted to identify pod-based e-cigarette–associated articles from June 2015 (the time when JUUL [JUUL Labs] was introduced) to June 2019. We included English-language articles that presented primary data on pod-based e-cigarettes. <h3>Findings</h3> Pod-based e-cigarettes represent a substantial evolution in design by increasing the efficient delivery of nicotine. While these products may contain less harmful constituents than other types of e-cigarettes and cigarettes, there is no evidence that the levels found are safe among youth. There is evidence for higher nicotine dependence associated with their use. Pod-based e-cigarette brands, compared with other e-cigarette brands, have targeted youth and young adults with social media marketing. There was less discussion about the use of these products as smoking cessation devices or their health risks on social media. The social acceptability and favorable perceptions of pod-based e-cigarettes may underlie the use of these products. <h3>Conclusions and Relevance</h3> The appeal and dependence potential of pod-based e-cigarettes for youth emphasize the need for stronger regulations on product design, social media, marketing channels, and youth access together with health communications that emphasize the risks of nicotine dependence.
Trial in progress: A phase Ib study of AMG 510, a specific and irreversible KRAS<sup>G12C</sup> inhibitor, in combination with other anticancer therapies in patients with advanced solid tumors harboring <i>KRAS</i> p.G12C mutation (CodeBreak 101).
Authors: Marwan Fakih, Greg Andrew Durm, Ramaswamy Govindan, Gerald Steven Falchook, Neelesh Soman, Haby Adel Henary, David S. Hong
Journal: Journal of Clinical Oncology (2020)

TPS3661 Background: Kirsten rat sarcoma viral oncogene homolog (KRAS) p.G12C mutation has been identified as a driver oncogenic mutation in several solid tumors (eg, non-small cell lung cancer [NSCLC], colorectal cancer [CRC]). Development of therapies targeting KRAS G12C has been unsuccessful. AMG 510 is a specific and irreversible small molecule inhibitor of KRAS G12C . A first-in-human clinical trial of AMG 510 monotherapy in patients with KRAS p.G12C mutant solid tumors is currently ongoing. AMG 510 in combination with additional anticancer therapies may lead to enhanced antitumor efficacy. This study is a master protocol designed to evaluate multiple investigational regimens of AMG 510 in patients with KRAS p.G12C mutant solid tumors. Here, we present two combination cohorts of AMG 510 with a mitogen-activated protein kinase kinase (MEK) inhibitor and an investigational anti-programmed cell death protein-1 (PD-1) therapy, respectively. Additional combination cohorts will be presented at the meeting. Methods: This is a phase 1b, open-label study evaluating AMG 510 in combination with a MEK inhibitor or an investigational anti-PD-1 therapy in pts with KRAS p.G12C mutant solid tumors. The dose exploration phase (part 1; n=20) will evaluate the safety and tolerability of AMG 510 in combination with the MEK inhibitor or anti-PD-1 therapy; this will be followed by a dose expansion phase (part 2; n=40) to verify the safety and tolerability profile of AMG 510 combination therapies and assess antitumor efficacy. Key eligibility criteria include locally-advanced or metastatic malignancy with KRAS p.G12C mutation identified through molecular testing and at least one or multiple lines of prior systemic therapy (eg, ≥2 for advanced/metastatic colorectal cancer). Primary endpoints include dose-limiting toxicities, treatment-emergent or -related adverse events. Secondary endpoints include pharmacokinetic parameters of combination regimens, disease control rate, duration of response, progression-free survival, and duration of stable disease (measured by computed tomography or magnetic resonance imaging and assessed per RECIST 1.1). The study began enrolling pts in December 2019 and is ongoing. For more information, please contact Amgen Medical Information: medinfo@amgen.com . Clinical trial information: NCT04185883 .
Cow’s milk protein β-lactoglobulin confers resilience against allergy by targeting complexed iron into immune cells
Authors: Franziska Roth-Walter, Sheriene Moussa Afify, Luis F. Pacios, Bart R. Blokhuis, Frank Redegeld, Andreas Regner, Lisa-Marie Petje, Alessandro Fiocchi, Eva Untersmayr, Zdenek Dvorak, Karin Hufnagl, Isabella Pali-Schöll, Erika Jensen-Jarolim
Journal: Journal of Allergy and Clinical Immunology (2020)
Phase I study of AMG 509, a STEAP1 x CD3 T cell-recruiting XmAb 2+1 immune therapy, in patients with metastatic castration-resistant prostate cancer (mCRPC).
Authors: W. Kevin Kelly, Daniel Costin Danila, William Jeffery Edenfield, Rahul Raj Aggarwal, Daniel Peter Petrylak, A. Oliver Sartor, Christopher Joseph Sumey, Tanya B. Dorff, Evan Y. Yu, Nabil Adra, David Michael Waterhouse, Andrew J. Armstrong, Lisa Horvath, David William Pook, Leonard Joseph Appleman, Aubrey Lau, Mark Salvati, Hosein Kouros-Mehr
Journal: Journal of Clinical Oncology (2020)

TPS5589 Background: Six transmembrane epithelial antigen of the prostate 1 (STEAP1) is a cell surface antigen that is highly expressed in prostate cancer. AMG 509 is a potent bispecific XmAb 2+1 immune therapy designed to direct T-effector cells to STEAP1-expressing cells. AMG 509 contains two identical humanized anti-STEAP1 Fab domains that bind STEAP1-expressing cells, an anti-CD3 scFv domain that binds T cells, and an Fc domain, engineered to lack effector function, that extends serum half-life. In preclinical studies, AMG 509 induced potent and specific T-cell-mediated lysis of STEAP1-expressing cancer models. Methods: This open-label, phase I, first-in-human study will evaluate the safety, tolerability, pharmacokinetics (PK), and efficacy of AMG 509 in patients with relapsed/refractory mCRPC. The dose exploration phase (n=40) will estimate the maximum tolerated dose (MTD) or recommended phase II dose (RP2D) using a Bayesian logistic regression model. The dose expansion phase (n=30) will confirm safety, PK, and pharmacodynamics at the MTD or RP2D and collect further safety, efficacy, and biomarker data. Efficacy will be assessed by prostate-specific antigen response, circulating tumor cell response, and objective tumor response per RECIST 1.1 with Prostate Cancer Working Group 3 modifications. Key inclusion criteria: men ≥18 years with histologically/cytologically confirmed mCRPC who are refractory to novel hormonal therapy (e.g., abiraterone and/or enzalutamide) and have failed 1–2 taxane regimens or are medically unsuitable for or have refused taxanes; ongoing castration with total serum testosterone ≤50 ng/dL; evidence of progressive disease; ECOG performance status 0–1; life expectancy ≥3 months; and adequate hematologic, renal, hepatic, and cardiac function. In the dose exploration phase, novel antiandrogen therapy must have been given in the metastatic setting. Key exclusion criteria: pure small-cell or neuroendocrine carcinoma of the prostate; untreated CNS metastases or leptomeningeal disease; any anticancer therapy or immunotherapy, radiation therapy, or major surgery &lt;4 weeks from first dose; history of or current autoimmune disease or any disease requiring immunosuppressive therapy (≤10 mg/d prednisone permitted); prior STEAP1-targeted therapy; infection requiring IV antimicrobials &lt;7 days from first dose. The study opened in January 2020 and is recruiting patients. Clinical trial information: NCT04221542 .
The importance of cardiovascular disease for mortality in patients with COPD: a prognostic cohort study
Authors: 刘岚
Journal: BMJ (2013)

背景
心血管疾病是慢性阻塞性肺疾病(COPD)患者的主要死亡原因，然而，在预测COPD患者预后方面却很少考虑心血管疾病因素。


目的
针对全科医师诊断的COPD患者定量分析心血管因素对其死亡风险的影响。


方法
诊断为COPD的患者405例，年龄≥65岁(其中244例通过肺活量检测)，随访平均4.2(标准差1.4)年。以Cox比例风险回归分析方法来明确患者总死亡(所有原因死亡)风险的独立预测因素。


结果
多变量分析显示年龄每增加1岁[风险比率1.05(95%CI：1.01～1.10)]、病史采集中有心绞痛[风险比率2.32(95%CI：1.50～3.58)]、一秒钟用力呼气容积(FEV1)与用力肺活量(FVC)比值下降所显示的气流阻塞增加[风险比率1.02(95%CI：1.01～1.03)]，以及CRP水平每增加1 mg/ml [风险比率1.04 (95%CI: 1.02～1.05]，均能分别预测患者的总死亡风险。应用向导技术后最终分析模型的C统计值为0.78 (95%CI: 0.72～0.83)，且该分析模型在244例经金标准诊断的COPD患者亚组中应用的结果也相似。


结论
在全科医师诊断COPD患者进行临床评估时，医生应考虑其有无缺血性心脏病的情况。病史采集中有心绞痛是患者总死亡风险的一个强烈的预测因子，应当予以合理的治疗以改善患者的预后。
The impact of estrogen receptor status on <i>EGFR/TP53</i>/<i>CTNNB1</i> axis in the evolution of non-small cell lung cancer.
Authors: Yoko Tani, Yasuhiro Koh, Akihiro Tamiya, Shun-ichi Isa, Akihito Kubo, Masahiko Ando, Hideo Saka, Motohiro Izumi, Koichi Ogawa, Yoshiya Matsumoto, Kenji Sawa, Naoki Yoshimoto, Tomohiro Suzumura, Tetsuya Watanabe, Hiroyasu Kaneda, Shigeki Mitsuoka, Kazuhisa Asai, Tomoya Kawaguchi
Journal: Journal of Clinical Oncology (2020)

e21035 Background: The role of estrogen receptor status in the carcinogenesis of lung cancer remains elusive. A census of clonal and sub-clonal mutations has been defined through the analyses of evolutionary histories of cancers. We previously reported a prospective multicenter molecular epidemiology study (JME study; Kawaguchi T, J Clin Oncol 2016), which included the expression levels of estrogen receptors β (ER) using immunohistochemistry(IHC) and the mutational profile using next generation sequencing as well as solid smoking information and reproductive/ hormonal risk factors from the detailed questionnaire. Methods: Utilizing the data of the JME study, the impact of ER in lung cancer development was explored. All the patients underwent surgery. In 441 ever- and 435 never-smokers, ER were observed in 46.4% and 53.5%, respectively. The cancer-associated 72 gene mutations and 5 gene amplifications examined in this study included EGFR, SMAD4, APC, FBXW7, BRAF, STK11, PIK3CA, TP53, PTEN, KRAS, CTNNB1, NFE2L2, NF1, and MET. ALK fusion was detected by IHC. Patients were enrolled between July 2012 and December 2013, with follow up until November 30th, 2017.Cox proportional hazards models were used to assess the ER expression on relapse free survival (RFS) and overall survival (OS). A logistic regression model was applied to assess the impact of ER (positive vs. negative) on gene alterations, using sex, smoking history, age and stage as independent variables. Results: ER expression was significantly higher in never smokers (vs. ever smokers; p = 0.022) and earlier stage (stage I vs. II-IV; p = 0.002). Patients with ER positive tumors had a longer RFS than those with negative tumors (RFS rate at 4 years: 33.7 vs. 26.5%; p = 0.021), however, there was no significant difference in OS between the two groups (p = 0.108). In the impact of ER status on the gene alterations, mutations in EGFR (p = 0.003), TP53 (p = 0.007) and CTNNB1 (p = 0.027) were significantly associated with ER expression. Multivariate analysis showed that EGFR mutations (OR = 1.394, 95%CI: 1.029-1.890, p = 0.032) and CTNNB1 mutations (OR = 0.272, 95%CI: 0.087-0.853, p = 0.026) were significantly associated with ER expression, while there was a trend for significance with TP53 mutations (OR = 0.737, 95%CI: 0.537-1.011, p = 0.059). Conclusions: ER positive status triggered the clonal EGFR mutations and suppressed the sub-clonal mutations of TP53 and CTNNB1. It is suggested that ER plays a critical role in the alterations of EGFR/TP53/ CTNNB1 axis in lung cancer evolution.