Prakaikietikul Pakorn, Tajarenmuang Pattraporn, Losuriya Phumiphat, Ina Natee, Ketpueak Thanika, Kanthawang Thanat
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
PLoS One. 2025 Feb 5;20(2):e0313577. doi: 10.1371/journal.pone.0313577. eCollection 2025.
To identify non-cancerous factors from baseline CT chest affecting survival in advanced non-small cell lung cancer (NSCLC) treated with first-generation Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs).
Retrospective study of 172 advanced NSCLC patients treated with first-generation EGFR-TKIs as a first-line systemic treatment (January 2012 to September 2022). Baseline CT chest assessed visceral/subcutaneous fat (L1 level), sarcopenia, and myosteatosis (multiple levels), main pulmonary artery (MPA) size, MPA to aorta ratio, emphysema, and bone mineral density. Cox regression analyzed prognostic factors at 18-month outcome.
Median overall survival was 17.57 months (14.87-20.10) with 76 (44.19%) patients died at 18 months. Deceased had lower baseline BMI (21.10 ± 3.44) vs. survived (23.25 ± 4.45) (p < 0.001). Univariable analysis showed 5 significant prognostic factors: low total adiposity with/without cutoff [HR 2.65 (1.68-4.18), p < 0.001; 1.00 (0.99-1.00), p = 0.006;], low subcutaneous adipose tissue (SAT) with/without cutoff [HR 1.95 (1.23-3.11), p = 0.005; 0.99 (0.98-0.99), p = 0.005], low SAT index (SATI) with/without cutoff [1.74 (1.10-2.78), p = 0.019; 0.98 (0.97-0.99), p = 0.003], high VSR [1.67 (1.06-2.62), p = 0.026], and high MPA size with/without cutoff [2.23 (1.23-4.04), p = 0.005; 1.09 (1.04-1.16), p = 0.001]. MPA size, MPA size > 29 mm, and total adiposity ≤85 cm2 remained significant in multivariable analysis, adjusted by BMI [HR 1.14 (1.07-1.21), p < 0.001; 3.10 (1.81-5.28), p < 0.001; 3.91 (1.63-9.40), p = 0.002]. There was no significant difference of sarcopenic and myosteatotic parameters between the two groups.
In advanced EGFR-mutated NSCLC patients, assessing pre-treatment prognosis is warranted to predict the survival outcome and guide decision regarding EGFR-TKI therapy. Enlarged MPA size, low total adiposity, and low subcutaneous fat (lower SAT, lower SATI, and higher VSR) are indicators of poor survival. Large MPA size (>29 mm) or low total adiposity (≤85 cm2) alone predict 18-month death.
确定基线胸部CT中影响接受第一代表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）治疗的晚期非小细胞肺癌（NSCLC）患者生存的非癌性因素。
对172例接受第一代EGFR-TKIs作为一线全身治疗的晚期NSCLC患者进行回顾性研究（2012年1月至2022年9月）。基线胸部CT评估内脏/皮下脂肪（L1水平）、肌肉减少症和肌少脂症（多个水平）、主肺动脉（MPA）大小、MPA与主动脉比值、肺气肿和骨密度。Cox回归分析18个月结局时的预后因素。
中位总生存期为17.57个月（14.87 - 20.10），76例（44.19%）患者在18个月时死亡。死亡患者的基线BMI较低（21.10±3.44），而存活患者为（23.25±4.45）（p<0.001）。单因素分析显示5个显著的预后因素：有/无临界值的低总脂肪量[风险比（HR）2.65（1.68 - 4.18），p<0.001；1.00（0.99 - 1.00），p = 0.006]、有/无临界值的低皮下脂肪组织（SAT）[HR 1.95（1.23 - 3.11），p = 0.005；0.99（0.98 - 0.99），p = 0.005]、有/无临界值的低SAT指数（SATI）[1.74（1.10 - 2.78），p = 0.019；0.98（0.97 - 0.99），p = 0.003]、高VSR[1.67（1.06 - 2.62），p = 0.026]以及有/无临界值的高MPA大小[2.23（1.23 - 4.04），p = 0.005；1.09（1.04 - 1.16），p = 0.001]。在多因素分析中，经BMI调整后，MPA大小、MPA大小>29 mm和总脂肪量≤85 cm²仍然显著[HR 1.14（1.07 - 1.21），p<0.001；3.10（1.81 - 5.28），p<0.001；3.91（1.63 - 9.40），p = 0.002]。两组之间的肌肉减少症和肌少脂症参数无显著差异。
在晚期EGFR突变的NSCLC患者中，有必要评估治疗前预后以预测生存结局并指导关于EGFR-TKI治疗的决策。MPA大小增大、总脂肪量低和皮下脂肪低（较低的SAT、较低的SATI和较高的VSR）是生存不良的指标。单独的大MPA大小（>29 mm）或低总脂肪量（≤85 cm²）可预测18个月死亡。
