Abstract
Many noninvasive methods have been explored to determine the mutation status of the epidermal growth factor receptor (EGFR) gene, which is important for individualized treatment of non-small cell lung cancer (NSCLC). We evaluated whether metabolic tumor volume (MTV), a parameter measured by [18F] fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) might help predict EGFR mutation status in NSCLC. Overall, 87 patients who underwent EGFR genotyping and pretreatment PET/CT between January 2013 and September 2016 were reviewed. Clinicopathologic characteristics and metabolic parameters including MTV were evaluated. Univariate and multivariate analyses were used to assess the independent variables that predict mutation status to create prediction models. Forty-one patients (41/87) were identified as having EGFR mutations. The multivariate analysis showed that patients with lower MTV (MTV≤11.0 cm3, p=0.001) who were non-smokers (p=0.037) and had a peripheral tumor location (p=0.033) were more likely to have EGFR mutations. Prediction models using these criteria for EGFR mutation yielded a high AUC (0.805, 95% CI 0.712–0.899), which suggests that the analysis had good discrimination. In conclusion, NSCLC patients with EGFR mutations showed significantly lower MTV than patients with wild-type EGFR. Prediction models based on MTV and clinicopathologic characteristics could provide more information for the identification of EGFR mutations.
Highlights
Treatment options for non-small cell lung cancer (NSCLC), the most predominant type of lung cancer, have developed rapidly due to the discovery and investigation of genetic drivers such as no epidermal growth factor receptor (EGFR) mutation (EGFR-)activating mutations [1, 2]
We evaluated whether metabolic tumor volume (MTV), a parameter measured by [18F] fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) might help predict EGFR mutation status in NSCLC
Individual gene detection has been recommended for advanced NSCLC; such assessment is often limited by tumor inaccessibility, insufficient sample tissue for detection and patients’ unwillingness to undergo invasive detection procedures [15]
Summary
Treatment options for NSCLC, the most predominant type of lung cancer, have developed rapidly due to the discovery and investigation of genetic drivers such as EGFR-activating mutations [1, 2]. EGFR genotype could help in the selection of patients who will benefit from TKIs when making treatment decisions. We previously discussed the role of PET/CT in staging, assessing therapy response and developing a radiotherapy plan for patients with NSCLC [6, 7]. PET/CT is based on the fact that the glucose metabolism of a tumor is partly reflected by FDG uptake. Processes downstream of the EGFR gene could influence glucose metabolism by regulating the synthesis of glucose-transporter-1 (GLUT1), which correlates with FDG uptake [8, 9]. FDG uptake might be associated with EGFR gene mutation in tumors
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