Ziv Etay, Erinjeri Joseph P, Yarmohammadi Hooman, Boas F Edward, Petre Elena N, Gao Song, Shady Waleed, Sofocleous Constantinos T, Jones David R, Rudin Charles M, Solomon Stephen B
From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.).
Radiology. 2017 Jan;282(1):251-258. doi: 10.1148/radiol.2016160003. Epub 2016 Jul 19.
Purpose To establish the relationship between KRAS mutation status and local recurrence after image-guided ablation of lung adenocarcinoma. Materials and Methods This study consisted of a HIPAA-compliant institutional review board-approved retrospective review of 56 primary lung adenocarcinomas in 54 patients (24 men, 30 women; median age, 72 years; range, 54-87 years) treated with percutaneous image-guided ablation and with available genetic mutational analysis. KRAS mutation status and additional clinical and technical variables-Eastern Cooperative Oncology Group (ECOG) status, smoking history, stage at diagnosis, status (new primary or not), history of radiation, history of surgery, prior systemic treatment, modality of ablation, size of nodule, ablation margin, and presence of ground-glass appearance-were recorded and evaluated in relation to time to local recurrence, which was calculated from the time of ablation to the first radiographic evidence of recurrence. Predictors of outcome were identified by using a proportional hazards model for both univariate and multivariate analysis, with death as a competing risk. Results Technical success was 100%. Of the 56 ablated tumors, 37 (66%) were wild type for KRAS and 19 (34%) were KRAS mutants. The 1-year and 3-year cumulative incidences of recurrence were 20% and 35% for wild-type KRAS compared with 40% and 63% for KRAS mutant tumors. KRAS mutation status was a significant predictor of local recurrence at both univariate (P = .05; subdistribution hazard ratio [sHR], 2.32) and multivariate (P = .006; sHR, 3.75) analysis. At multivariate analysis, size (P = .026; sHR, 2.54) and ECOG status (P = .012; sHR, 2.23) were also independent significant predictors, whereas minimum margin (P = .066) was not. Conclusion The results of this study show that there is a relationship between KRAS mutation status and local recurrence after image-guided ablation of lung adenocarcinoma. Specifically, KRAS mutation status of the ablated lesion is a significant predictor of time to local recurrence, independent of size and margin. RSNA, 2016.
目的 建立影像引导下肺腺癌消融术后KRAS突变状态与局部复发之间的关系。材料与方法 本研究为一项符合健康保险流通与责任法案（HIPAA）的机构审查委员会批准的回顾性研究，纳入了54例患者的56例原发性肺腺癌（男性24例，女性30例；中位年龄72岁；范围54 - 87岁），这些患者接受了经皮影像引导下消融治疗且有可用的基因变异分析。记录并评估KRAS突变状态以及其他临床和技术变量——东部肿瘤协作组（ECOG）状态、吸烟史、诊断时的分期、状态（是否为新发原发性肿瘤）、放疗史、手术史、既往全身治疗情况、消融方式、结节大小、消融边缘以及磨玻璃样表现的存在情况，并与局部复发时间相关联，局部复发时间从消融时间计算至首次影像学复发证据出现的时间。通过使用比例风险模型进行单因素和多因素分析来确定预后的预测因素，将死亡作为竞争风险。结果 技术成功率为100%。在56个消融肿瘤中，37个（66%）KRAS为野生型，19个（34%）为KRAS突变型。KRAS野生型肿瘤的1年和3年累积复发率分别为20%和35%，而KRAS突变型肿瘤分别为40%和63%。在单因素分析（P = 0.05；亚分布风险比[sHR]，2.32）和多因素分析（P = 0.006；sHR，3.75）中，KRAS突变状态都是局部复发的显著预测因素。在多因素分析中，大小（P = 0.026；sHR，2.54）和ECOG状态（P = 0.
