Main Article Content
Increased understanding in molecular pathology of advanced non-small cell lung cancer (NSCLC) over the past decades has led to personalized treatment approaches being advocated. Epidermal growth factor receptor (EGFR) mutation that often occurs in NSCLC can be identified using immunohistochemical examinations. Moreover, clarifying the relationship between computed tomography (CT) and EGFR mutation of NSCLC might inform therapeutic decision-making. The purpose of this study was to determine the relationship between metastatic sites on primary chest CT-scan and EGFR mutation in NSCLC lung cancer patients.
An cross-sectional design using secondary data was conducted, involving 76 NSCLC patients. EGFR mutations were determined by immunohistochemical examination and metastatic sites by chest CT-scan with contrast. The collected metastatic sites comprised hilar and mediastinal lymphadenopathy, pulmonary nodules, and bone, liver, spleen and suprarenal metastases. A Chi square test was used to analyze the data.
This study revealed that the highest NSCLC stage was IVb, found in 39 samples (51.3%), while 34 (44.7%) subjects had EGFR mutation. There was no statistically significant difference between metastatic site and positive EGFR mutation, although positive bone metastases (54.8%) tend to have more numerous positive EGFR mutations compared to negative bone metastases (37.7%) (p=0.142).
Patients with positive bone metastases tend to have higher positive EGFR mutation compared to negative bone metastases in NSCLC lung cancer patients. Prospective studies evaluating patients with EGFR mutation for bone metastases should be considered. This can provide information on therapeutic decision-making to obtain good clinical outcomes.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.The journal allow the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.
Zappa C, Mousa SA. Non-small cell lung cancer: current treatment and future advances. Transl Lung Cancer Res 2016;5:288–300. doi: 10.21037/tlcr.2016.06.07.
Grigoriu B, Berghmans T, Meert AP. Management of EGFR mutated nonsmall cell lung carcinoma patients. Eur Respir J 2015;45:1132–41. doi: 10.1183/09031936.00156614.
Yoneda K, Imanishi N, Ichiki Y, Tanaka F. Treatment of non-small cell lung cancer with EGFR-mutations. J UOEH 2019;41:153-63. doi: 10.7888/juoeh.41.153.
Choi YL, Sun JM, Cho J, et al. EGFR mutation testing in patients with advanced non-small cell lung cancer: a comprehensive evaluation of real-world practice in an East Asian tertiary hospital. PLoS One 2013;8:e56011. doi: 10.1371/journal. pone.0056011.
Haralsingh A, West M. Tissue yields for epidermal growth factor receptor analysis in non-small cell lung cancer patients in Trinidad and Tobago. Cureus 2021;13:e12531. doi: 10.7759/cureus.12531.
Purandare NC, Rangarajan V. Imaging of lung cancer: Implications on staging and management. Indian J Radiol Imaging 2015;25:109–20. doi: 10.4103/0971-3026.155831.
Jonas DE, Reuland DS, Reddy SM, et al. Screening for lung cancer with low-dose computed tomography: updated evidence report and systematic review for the US Preventive Services Task Force. J Am Med Assoc 2021;325:971–87. doi: 10.1001/jama.2021.0377.
Hasegawa M, Sakai F, Ishikawa R, Kimura F, Ishida H, Kobayashi K. CT features of epidermal growth factor receptor-mutated adenocarcinoma of the lung: Comparison with nonmutated adenocarcinoma. J Thorac Oncol 2016;11:819–26. http://dx.doi.org/10.1016/j.jtho.2016.02.010.8.
Qiu X, Yuan H, Sima B. Relationship between EGFR mutation and computed tomography characteristics of the lung in patients with lung adenocarcinoma. Thorac Cancer 2019;10:170–4. doi: 10.1111/1759-7714.12928.
Liu Y, Kim J, Qu F, et al. CT features associated with epidermal growth factor receptor mutation status in patients with lung adenocarcinoma. Radiology 2016;280:271–80. doi: 10.1148/radiol.2016151455.
Han X, Fan J, Li Y, et al. Value of CT features for predicting EGFR mutations and ALK positivity in patients with lung adenocarcinoma. Sci Rep 2021;11:1–13. doi: 10.1038/s41598-021-83646-7.11.
Shen TX, Liu L, Li WH, et al. CT imaging-based histogram features for prediction of EGFR mutation status of bone metastases in patients with primary lung adenocarcinoma. Cancer Imaging 2019;19:34. https://doi.org/10.1186/s40644-019-0221-9.12.
Lee CC, Soon YY, Tan CL, et al. Discordance of epidermal growth factor receptor mutation between primary lung tumor and paired distant metastases in non-small cell lung cancer: a systematic review and meta-analysis. PLoS ONE 2019;14:e0218414. https://doi.org/10.1371/journal. pone.0218414
Zhang S, Yan B, Zheng J, Zhao J, Zhou J. Gene status and clinicopathologic characteristics of lung adenocarcinomas with mediastinal lymph node metastasis. Oncotarget 2016;7:63758–66. doi: 10.18632/oncotarget.11494.
Liu Z, Liang H, Lin J, et al. The incidence of lymph node metastasis in patients with different oncogenic driver mutations among T1 non-small-cell lung cancer. Lung Cancer 2019;134:218–24. doi: 10.1016/j.lungcan.2019.06.026.
Digumarthy SR, Mendoza DP, Padole A, et al. Diffuse lung metastases in EGFR-mutant non-small cell lung cancer. Cancers (Basel) 2019;11: 1360. doi:10.3390/cancers11091360.
Wu SG, Hu FC, Chang YL, et al. Frequent EGFR mutations in nonsmall cell lung cancer presenting with miliary intrapulmonary carcinomatosis. Eur Respir J 2013;41:417–24. doi: 10.1183/09031936. 00006912.
Hsu F, De Caluwe A, Anderson D, Nichol A, Toriumi T, Ho C. Patterns of spread and prognostic implications of lung cancer metastasis in an era of driver mutations. Curr Oncol 2017;24:228–33. doi: 10.3747/co.24.3496.
Santini D, Barni S, Intagliata S, et al. Natural history of non-small-cell lung cancer with bone metastases. Sci Rep 2015; 5 :18670. https://doi.org/10.1038/srep18670
Laganà M, Gurizzan C, Roca E, et al. High prevalence and early occurrence of skeletal complications in EGFR mutated NSCLC patients with bone metastases. Front Oncol 2020;10: 588862. doi: 10.3389/fonc.2020.588862.
Krawczyk P, Kowalski DM, Ramlau R, et al. Comparison of the effectiveness of erlotinib, gefitinib, and afatinib for treatment of non-small cell lung cancer in patients with common and rare EGFR gene mutations. Oncol Lett 2017;13:4433–44. doi: 10.3892/ol.2017.5980.
Kuijpers CCHJ, Hendriks LEL, Derks JL, et al. Association of molecular status and metastatic organs at diagnosis in patients with stage IV non-squamous non-small cell lung cancer. Lung Cancer 2018;121:76–81. https://doi.org/10.1016/j.lungcan.2018.05.006.
Beypinar I, Demir H, Araz M, Uysal M. The relationship between EGFR mutation and metastasis pattern in lung adenocarcinoma. J Oncol Sci 2019;5:65–9. https://doi.org/10.1016/j.jons.2019.08.002.
Belli A, De Luca G, Bianco F, et al. An unusual metastatic site for primary lung cancer: the spleen. J Thorac Oncol 2016;11:128–9. https://dx.doi.org/10.1016/j.jtho.2015.08.005.
Mitsimponas N, Mitsogianni M, Crespo F, et al. Isolated splenic metastasis from non-small-cell lung cancer: a case report and review of the literature. Case Rep Oncol 2017;10:638–43. https://doi.org/10.1159/000478002.
Bazhenova L, Newton P, Mason J, Bethel K, Nieva J, Kuhn P. Adrenal metastases in lung cancer: clinical implications of a mathematical model. J Thorac Oncol 2014;9:442-6. doi: 10.1097/JTO.0000000000000133.