1 Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea.
2 Yonsei Biomedical Research Institute, Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2018 Jan;210(1):43-51. doi: 10.2214/AJR.17.18167. Epub 2017 Nov 1.
The purpose of this study is to investigate adverse prognostic CT findings in patients with advanced-stage lung adenocarcinoma who are receiving epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy as first-line therapy.
We included 199 patients (71 men and 128 women; mean ± SD age, 64.3 ± 11.2 years) with stage IIIB or IV lung adenocarcinoma who received first-line EGFR-TKI therapy between January 2009 and December 2015. Clinical findings and imaging parameters on CT images obtained before TKI therapy were analyzed, including tumor size, TNM category according to the seventh edition of the American Joint Committee on Cancer lung cancer TNM staging system, tumor type, the presence of cavity or necrosis, pleural effusion, and metastasis to pleura, lung, and distant organs. Response evaluation was performed according to the Response Evaluation Criteria in Solid Tumor version 1.1 guidelines. Correlation of clinical and radiologic findings with durations of progression-free survival (PFS) and overall survival (OS) was evaluated using a Cox proportional hazard model.
Pleural effusion (hazard ratio [HR], 2.095; 95% CI, 1.394-3.147; p < 0.001) and an N2 or N3 tumor category (HR, 2.145; 95% CI, 1.280-3.594; p = 0.004) were significantly associated with a short PFS duration in multivariate analysis. Older age (HR, 1.040; 95% CI, 1.014-1.067; p = 0.002), an N2 or N3 tumor category (HR, 2.427; 95% CI, 1.068-5.518; p = 0.034), pleural effusion (HR, 1.903; 95% CI, 1.105-3.276; p = 0.020), and distant metastasis (HR, 2.795; 95% CI, 1.356-5.765; p = 0.005) were associated with a short OS duration in multivariate analysis.
Pre-TKI therapy CT findings of pleural effusion and high N-category tumors are associated with short durations of PFS and OS in patients with lung adenocarcinoma who are receiving EGFR-TKI therapy.
本研究旨在探讨晚期肺腺癌患者接受表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKI）一线治疗时，不良预后 CT 表现。
我们纳入了 199 例（71 名男性，128 名女性；平均年龄 64.3±11.2 岁）接受 EGFR-TKI 一线治疗的 IIIB 期或 IV 期肺腺癌患者。分析了患者 TKI 治疗前 CT 图像上的临床发现和影像学参数，包括肿瘤大小、根据美国癌症联合委员会肺癌 TNM 分期系统第 7 版的 TNM 分期、肿瘤类型、空洞或坏死、胸腔积液以及胸膜、肺和远处器官转移的存在。根据实体瘤反应评价标准 1.1 版进行疗效评价。采用 Cox 比例风险模型评价临床和影像学表现与无进展生存期（PFS）和总生存期（OS）的相关性。
多因素分析显示，胸腔积液（风险比[HR]，2.095；95%可信区间[CI]，1.394-3.147；p＜0.001）和 N2 或 N3 肿瘤分期（HR，2.145；95%CI，1.280-3.594；p=0.004）与较短的 PFS 时间显著相关。年龄较大（HR，1.040；95%CI，1.014-1.067；p=0.002）、N2 或 N3 肿瘤分期（HR，2.427；95%CI，1.068-5.518；p=0.034）、胸腔积液（HR，1.903；95%CI，1.105-3.276；p=0.020）和远处转移（HR，2.795；95%CI，1.356-5.765；p=0.005）与接受 EGFR-TKI 治疗的肺腺癌患者较短的 OS 时间相关。
肺腺癌患者接受 EGFR-TKI 治疗前 CT 表现为胸腔积液和高 N 分期肿瘤与较短的 PFS 和 OS 时间相关。
