Park Sohee, Lee Sang Min, Ahn Yura, Kim Minjae, Suh Chong Hyun, Do Kyung-Hyun, Seo Joon Beom
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea.
Eur Radiol. 2022 Feb;32(2):990-1001. doi: 10.1007/s00330-021-08215-y. Epub 2021 Aug 10.
To identify clinical and staging chest CT characteristics predictive of brain metastasis in patients with newly diagnosed NSCLC dichotomized according to resectability.
Patients newly diagnosed with NSCLC of clinical stages II-IV between November 2017 and October 2018 were enrolled and classified into resectable (stage II+IIIA) and unresectable stages (stage IIIB/C+IV) according to chest CT. Associations of clinicopathological characteristics and CT findings with brain metastasis were analyzed using logistic regression. Predictive models were evaluated using receiver operating characteristics curve analysis. A subgroup analysis for unresectable-stage patients with known epidermal growth factor receptor gene (EGFR) mutation status was performed.
This study included 911 NSCLC patients (mean age, 65 ± 11 years; 620 men), 194 of whom were diagnosed with brain metastasis. For resectable stages, independent predictors for brain metastasis were N2-stage (13 of 25 patients), absence of air-bronchogram/bubble lucency (23 of 25 patients), and presence of spiculation (15 of 25 patients), with a model combining the two imaging features showing an AUC of 0.723. In unresectable stages, independent predictors of brain metastasis were younger age, female sex, extrathoracic metastasis, and adenocarcinoma, with models combining these showing AUCs of 0.675-0.766. In the subgroup with known EGFR-mutation status, extrathoracic metastasis and positive EGFR mutation were independent predictors of brain metastasis, with the model showing AUCs of 0.641-0.732.
CT-derived imaging features, clinical stages, lung cancer subtype, and EGFR mutation were associated with brain metastasis in patients with newly diagnosed NSCLC. The predictors were completely different between resectable and unresectable stages.
• In resectable stages of NSCLC, two imaging features (absence of air-bronchogram/bubble lucency and presence of spiculation) and N2 stage were independent predictors of brain metastasis. • In unresectable stages of NSCLC, younger age, female sex, extrathoracic metastasis, and adenocarcinoma were associated with brain metastasis. • In the subgroup of NSCLC with known EGFR-mutation status, extrathoracic metastasis and positive EGFR mutation were independent predictors of brain metastasis.
确定根据可切除性进行二分法的新诊断非小细胞肺癌（NSCLC）患者发生脑转移的临床和分期胸部CT特征。
纳入2017年11月至2018年10月新诊断为临床II-IV期NSCLC的患者，并根据胸部CT将其分为可切除组（II+IIIA期）和不可切除组（IIIB/C+IV期）。使用逻辑回归分析临床病理特征和CT表现与脑转移的相关性。使用受试者操作特征曲线分析评估预测模型。对已知表皮生长因子受体基因（EGFR）突变状态的不可切除期患者进行亚组分析。
本研究纳入911例NSCLC患者（平均年龄65±11岁；男性620例），其中194例诊断为脑转移。对于可切除期，脑转移的独立预测因素为N2期（25例患者中的13例）、无空气支气管造影/气泡透亮影（25例患者中的23例）和有毛刺征（25例患者中的15例），结合这两种影像特征的模型AUC为0.723。在不可切除期，脑转移的独立预测因素为年龄较小、女性、胸外转移和腺癌，结合这些因素的模型AUC为0.675-0.766。在已知EGFR突变状态的亚组中，胸外转移和EGFR突变阳性是脑转移的独立预测因素，模型AUC为0.641-0.732。
CT衍生的影像特征、临床分期、肺癌亚型和EGFR突变与新诊断NSCLC患者的脑转移相关。可切除期和不可切除期的预测因素完全不同。
• 在NSCLC的可切除期，两种影像特征（无空气支气管造影/气泡透亮影和有毛刺征）和N2期是脑转移的独立预测因素。• 在NSCLC的不可切除期，年龄较小、女性、胸外转移和腺癌与脑转移相关。• 在已知EGFR突变状态的NSCLC亚组中，胸外转移和EGFR突变阳性是脑转移的独立预测因素。
