Abstract
BackgroundWe aimed to analyze the first progression sites of first-line tyrosine kinase inhibitor (TKI) treatment for EGFR-mutant lung adenocarcinoma patients with systemic metastasis to recognize the potential candidates who might benefit from radiotherapy and establish a radiomic-based model to predict the first progression sites.Materials and MethodsWe retrospectively collected the clinical information and pre-treatment chest CT images of patients in Shanghai Chest Hospital from 2013 to 2017. All patients were diagnosed with stage IV EGFR-mutant lung adenocarcinoma and received TKI as first-line treatment. The first progression sites and survival were analyzed. The pre-treatment chest non-contrast CT images were utilized to establish a radiomic-based model to predict the first progression sites.ResultsWe totally collected 233 patients with systemic metastasis, among whom, there were 84 (36.1%) and 149 (63.9%) patients developing first progression in original lesions (OP) and new lesions (NP), respectively. The PFS and OS of patients with OP were longer than those with NP (PFS 11 months vs. 8 months, p = 0.03, OS 50 months vs. 35 months, p = 0.046). For 67.9% of the patients with OF, disease progressed within five sites (oligoprogression). The radiomic-based model could predict the progression sites with an AUC value of 0.736, a specificity of 0.60, and a sensitivity of 0.750 in the independent validation set.ConclusionAmong patients with systemic metastasis, there were 36.1% of patients developing OP at first progression who had a better prognosis than those developing NP. Patients with OP may be potential candidates who might benefit from radiotherapy. Radiomics is a useful method to distinguish patients developing OP and could provide some indications for radiotherapy.
Highlights
First-line targeted therapy with tyrosine kinase inhibitor (TKI) is recommended as the standard treatment for stage IV EGFR-mutant lung adenocarcinoma
The inclusion criteria were as follows: (a) EGFR mutation confirmed by ARMS or NGS; (b) stage IV with systemic metastasis confirmed by radiological examinations; (c) first-line targeted therapy with TKIs; (d) routine follow-up every 3 months with brain MRI and thoracic and abdominal CT; bone scan was undertaken every half a year; (e) accurate restaging at disease progression confirmed by brain MRI, thoracic and abdominal CT, and bone scan; and (f) available pre-treatment chest CT images with scanning thickness less than 5 mm
Given that the prognosis of patients with systemic metastasis was not inferior to that of patients with oligometastasis [15], it was worthwhile to explore whether radiotherapy could increase the progressionfree survival (PFS) and overall survival (OS) for patients with systemic metastasis receiving first-line TKI treatment
Summary
First-line targeted therapy with tyrosine kinase inhibitor (TKI) is recommended as the standard treatment for stage IV EGFR-mutant lung adenocarcinoma. Radiomics is a cuttingedge technology to analyze medical imaging, which could extract discernable biological information to instruct clinical practice [9] For this purpose, we proposed to analyze the first progression sites of first-line TKI treatment for EGFR-mutant lung adenocarcinoma patients with systemic metastasis and establish a radiomic-based model to predict the first progression sites, which might help to recognize the potential candidates who might benefit from radiotherapy. We aimed to analyze the first progression sites of first-line tyrosine kinase inhibitor (TKI) treatment for EGFR-mutant lung adenocarcinoma patients with systemic metastasis to recognize the potential candidates who might benefit from radiotherapy and establish a radiomic-based model to predict the first progression sites
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
