Wang Yangyang, Zhang Yongyuan, Ren Nana, Li Fangting, Lu Lin, Zhao Xin, Zhou Zhigang, Gao Mengyu, Wang Meng
Department of Medical Imaging, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Medical Imaging, Zhengzhou People's Hospital, Zhengzhou, China.
Front Oncol. 2024 May 13;14:1367603. doi: 10.3389/fonc.2024.1367603. eCollection 2024.
The safety and feasibility of repeat biopsy after systemic treatment for non-small cell lung cancer have received extensive attention in recent years. The purpose of this research was to compare complication rates between initial biopsy and rebiopsy in non-small cell lung cancer patients with progressive disease and to assess complication risk factors and clinical results after rebiopsy.
The study included 113 patients initially diagnosed with non-small cell lung cancer who underwent lung biopsy at initial biopsy and rebiopsy after progression while on epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and/or chemotherapy from January 2018 to December 2021. We compared the incidence of complications between the initial biopsy and rebiopsy and analyzed the predictors factors that influenced complications in patients who underwent rebiopsy.
The successful rate of rebiopsy was 88.5% (100/113). With the exception of two cases where lung adenocarcinoma changed into small cell lung cancer with gefitinib treatment, 98 individuals retained their initial pathological type. The secondary EGFR T790M mutation accounts for 55.6% of acquired resistance. The total number of patients with complications in initial biopsy was 25 (22.1%) and 37 (32.7%) in the rebiopsy. The incidence of pulmonary hemorrhage increased from 7.1% at the initial biopsy to 10.6% at rebiopsy, while the incidence of pneumothorax increased from 14.2% to 20.4%. Compared with the initial biopsy, the incidence of overall complications, parenchymal hemorrhage, and pneumothorax increased by 10.6%, 3.5%, and 6.2%, respectively. In all four evaluations (pneumorrhagia, pneumothorax, pleural reaction, and overall complication), there were no significant differences between the rebiopsy and initial biopsy (all > 0.05). The multivariate logistic regression analysis suggested that male sex (odds ratio [OR] = 5.064, = 0.001), tumor size ≤ 2 cm (OR = 3.367, = 0.013), EGFR-TKIs with chemotherapy (OR = 3.633, =0.023), and transfissural approach (OR = 7.583, = 0.026) were independent risk factors for overall complication after rebiopsy.
Compared with the initial biopsy, the complication rates displayed a slight, but not significant, elevation in rebiopsy. Male sex, tumor size ≤ 2 cm, transfissural approach, and EGFR-TKIs combined with chemotherapy were independent risk factors for rebiopsy complications.
近年来，非小细胞肺癌全身治疗后重复活检的安全性和可行性受到广泛关注。本研究旨在比较疾病进展的非小细胞肺癌患者初次活检和再次活检的并发症发生率，并评估再次活检后的并发症危险因素及临床结果。
本研究纳入了113例最初诊断为非小细胞肺癌的患者，这些患者在2018年1月至2021年12月期间接受了初次活检，并在疾病进展后接受了表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）和/或化疗，之后进行了再次活检。我们比较了初次活检和再次活检的并发症发生率，并分析了影响再次活检患者并发症的预测因素。
再次活检成功率为88.5%（100/113）。除2例肺腺癌经吉非替尼治疗转变为小细胞肺癌外，98例患者病理类型保持不变。继发性EGFR T790M突变占获得性耐药的55.6%。初次活检并发症患者总数为25例（22.1%），再次活检为37例（32.7%）。肺出血发生率从初次活检时的7.1%升至再次活检时的10.6%，气胸发生率从14.2%升至20.4%。与初次活检相比，总体并发症、实质出血和气胸发生率分别增加了10.6%、3.5%和6.2%。在所有四项评估（肺出血、气胸、胸膜反应和总体并发症）中，再次活检与初次活检之间均无显著差异（均>0.05）。多因素logistic回归分析表明，男性（比值比[OR]=5.064，P=0.001）、肿瘤大小≤2 cm（OR=3.367，P=0.013）、EGFR-TKIs联合化疗（OR=3.633，P=0.023）和经叶间裂入路（OR=7.583，P=0.026）是再次活检后总体并发症的独立危险因素。
与初次活检相比，再次活检并发症发生率略有升高，但差异无统计学意义。男性、肿瘤大小≤2 cm、经叶间裂入路以及EGFR-TKIs联合化疗是再次活检并发症的独立危险因素。
