Chen Jing-Yu, Zhu Ying, Liu Bao-Cong, Ma Hui-Yun, Li Lu-Jie, Chen Mei-Cheng, Zhou Shu-Chang, Li Xiang-Min, Long Jian-Ting, Li Qiong
Department of Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Thorac Dis. 2024 Nov 30;16(11):7244-7256. doi: 10.21037/jtd-24-724. Epub 2024 Nov 29.
With the development of tyrosine kinase inhibitor (TKI) treatment, the prognosis of advanced lung adenocarcinoma (LUAD) patients with epidermal growth factor receptor () mutations has been continuously improving. This study aims to propose the utilization of pathological characteristics and imaging features to evaluate the impact of gene mutations on the prognosis of T1-4N0M0 LUAD.
Among the cases diagnosed with LUAD between April 2015 and April 2016, 438 patients with T1-4N0M0 LUAD were included, and the clinical characteristics were collected. mutations were analyzed in these patients who underwent lobectomy with different radiological and pathological types for the relation to patient prognosis.
Patients with mutation had longer recurrence-free survival (RFS) in part-solid nodules cohort (P=0.03), which was in contrast to purely solid nodules (P=0.06). Positive mutations significantly prolonged RFS in nodules consolidation-to-tumor ratio (CTR) values of 0-0.5. In the International Association for the Study of Lung Cancer (IASLC) grade I patients with mutations, there was a trend towards longer RFS but with no effect on overall survival (OS) (P=0.08; P=0.71); in IASLC grade II patients with mutations, there was a tendency of longer OS (P=0.06); in IASLC grade III patients with mutations, both RFS and OS were significantly shorter (P=0.02; P=0.005). mutation state was not an independent risk factors for both RFS and OS.
mutations are associated with a favorable prognosis in nodules with lower IASLC grading or more ground glass opacity (GGO) components. The results were reversed in patients with higher IASLC grading or no GGO component.
随着酪氨酸激酶抑制剂（TKI）治疗的发展，表皮生长因子受体（）突变的晚期肺腺癌（LUAD）患者的预后不断改善。本研究旨在利用病理特征和影像学特征评估基因突变对T1-4N0M0期LUAD患者预后的影响。
纳入2015年4月至2016年4月诊断为LUAD的病例中的438例T1-4N0M0期LUAD患者，收集其临床特征。对这些接受不同放射学和病理类型肺叶切除术的患者进行基因突变分析，以探讨其与患者预后的关系。
在部分实性结节队列中，基因突变患者的无复发生存期（RFS）较长（P=0.03），这与纯实性结节情况相反（P=0.06）。在实性成分与肿瘤比例（CTR）值为0-0.5的结节中，阳性基因突变显著延长了RFS。在国际肺癌研究协会（IASLC）I级有基因突变的患者中，有RFS延长的趋势，但对总生存期（OS）无影响（P=0.08；P=0.71）；在IASLC II级有基因突变的患者中，有OS延长的趋势（P=0.06）；在IASLC III级有基因突变的患者中，RFS和OS均显著缩短（P=0.02；P=0.005）。基因突变状态不是RFS和OS的独立危险因素。
在IASLC分级较低或磨玻璃影（GGO）成分较多的结节中，基因突变与良好预后相关。在IASLC分级较高或无GGO成分的患者中，结果相反。
