Abstract
The exon 19 and 21 in Epidermal Growth Factor Receptor (EGFR) mutation are the most common subtype of lung adenocarcinoma, and the strongest predictive biomarker for progression-free survival and tumor response. Although some studies have shown differences in radiological features between cases with and without EFGR mutations, they lacked necessary stratification. This article is to evaluate the association of CT features between the wild type and the subtype (exon 19 and 21) of EGFR mutations in patients with lung adenocarcinoma. Of the 721 finally included patients, 132 were positive for EGFR mutation in exon 19, 140 were positive for EGFR mutation in exon 21, and 449 were EGFR wild type. EGFR mutation in exon 19 was associated with a small-maximum diameter (28.51 ± 14.07) (p < 0.0001); sex (p < 0.0001); pleural retraction (p = 0.0034); and the absence of fibrosis (p < 0.0001), while spiculated margins (p = 0.0095), subsolid density (p < 0.0001) and no smoking (p < 0.0001) were associated with EGFR mutation in exon 21. Receiver Operating Characteristic (ROC) curves suggested that the maximum Area Under the Curve (AUC) was related to the female gender (AUC = 0.636) and the absence of smoking (AUC = 0.681). This study demonstrated the radiological and clinical features could be used to prognosticate EGFR mutation subtypes in exon 19 and 21.
Highlights
In-frame insertion) which have been documented in exon through 21, highlighting that deletion mutation in exon (45%) and point mutation in exon 21 (40–45%) are two most common mutations, accounting for about 90% Epidermal Growth Factor Receptor (EGFR) mutations in lung adenocarcinoma[4]
Multiple logistic regression analysis showed that small maximum diameter, sex (OR, 0.380; 95% confidence intervals (CI), 0.250–0.577), pleural retraction (OR, 2.093; 95% CI, 1.341–3.266), and the absence of fibrosis (OR, 0.288; 95% CI, 0.138–0.600) were important predictors of EGFR mutation in exon 19, where the Area Under the Curve (AUC) of Receiver Operating Characteristic (ROC) was 0.607,0.636,0.602 and 0.571, respectively (Fig. 1)
Subsequent multivariate analysis confirmed the significance of these features with evidence of three further significant features, which were spiculated margins (OR, 3.330; 95% CI, 1.819–6.097), subsolid density (OR, 0.304; 95% CI, 0.178–0.520), and no smoking (OR, 0.195; 95% CI, 0.121– 0.316)
Summary
In-frame insertion) which have been documented in exon through 21, highlighting that deletion mutation in exon (45%) and point mutation in exon 21 (40–45%) are two most common mutations, accounting for about 90% EGFR mutations in lung adenocarcinoma[4]. What’s more, some researchers thought that if CT-based radiological features associated with the EGFR mutation status could be determined, they could provide a useful clinical predictor in patients with unresectable lung cancer or those whose biopsy is unable to be performed[20]. The findings of the relationship between CT features and EGFR mutation status in NSCLC are not consistent with each other. None of these studies reported radiological characterization between the subtypes (exon 19 and 21) of EGFR mutation and wild type. We performed a radiological analysis to identify some helpful features of EGFR subtype mutation in lung adenocarcinomas in a Chinese cohort of patients
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