Association Between Computed Tomographic Features and Kirsten Rat Sarcoma Viral Oncogene Mutations in Patients With Stage I Lung Adenocarcinoma and Their Prognostic Value

Abstract

Background To investigate the association between computed tomographic (CT) features and KRAS mutations in patients with stage I lung adenocarcinoma and their prognostic value. Patients and Methods Seventy-nine patients with pathologic stage I lung adenocarcinoma, available KRAS mutational status, preoperative CT images, and survival data were included in the study. Seven CT features including spiculation, concavity, ground-glass opacity, bubblelike lucency, air bronchogram, pleural retraction, and pleural attachment were evaluated. The association between the clinical characteristics, CT features and mutational status was analyzed using Student's t test, Chi-square or Fisher's exact test, and logistic regression. The association between CT features, mutational status, and overall survival was analyzed using Kaplan-Meier survival curves with the log-rank test and Cox proportional hazard regression. Results The prevalence of KRAS mutations was 41.77%. Spiculation was significantly associated with KRAS mutations (OR = 2.99; 95% CI = 1.16 – 7.68). While KRAS mutational status was not significantly associated with overall survival, presence of pleural attachment was associated with an increased risk of death (HR = 2.46; 95% CI = 1.09 – 5.53). When analyzing combined KRAS mutational status and pleural attachment, patients with wild-type KRAS and no pleural attachment had significantly better survival compared to those with wild-type KRAS and with pleural attachment (p = 0.014). Conclusion These data suggest that spiculation was associated with KRAS mutations while pleural attachment was associated with overall survival in patients with stage I lung adenocarcinoma. Combining analysis of KRAS mutational status and CT features could better predict survival.

Analysis of the clinicopathological characteristics, genetic phenotypes, and prognostic of pure mucinous adenocarcinoma

“…As reported in previous research, guidelines for PMA therapy have not been clearly established, and additional research is needed to resolve this important question. Additionally, many studies had demonstrated that pleural invasion was significantly associated with an increased risk of survival . However, we observed that pleural invasion is a favorable prognostic factor in univariate analysis in our study; it indicates that pleural invasion has an interaction with another variable, such as AJCC stage and chemotherapy.…”

Somatic Mutations Drive Distinct Imaging Phenotypes in Lung Cancer

“…These studies generally had small sample sizes, used subjective observer-dependent imaging descriptors, and did not perform robust external validation. For example, associations have been reported between textural imaging features and KRAS mutations in combined imaging modalities (CT, 18 F- FDG PET and dynamic contrast-enhanced CT) in colorectal cancer(25), and using CT in NSCLC(27,47), but within small cohorts (<100 patients), and, more importantly, without external validation, which is a critical component of radiomic analyses(9,10). Our analysis of radiomic features extracted from CT images found that they had relatively weak predictive power for KRAS, a result that we validated in an independent validation set, indicating a generally similar imaging phenotype for KRAS-positive and negative tumors.…”

“…Our analysis of radiomic features extracted from CT images found that they had relatively weak predictive power for KRAS, a result that we validated in an independent validation set, indicating a generally similar imaging phenotype for KRAS-positive and negative tumors. For instance, Wang et al, found a single semantic CT feature, tumor spiculation, to be associated with the presence of KRAS mutations in a single cohort of stage I lung adenocarcinoma patients(47). We found, however, that EGFR-positive and negative tumors exhibit distinct imaging phenotypes, allowing more sensitive and specific classification of tumor EGFR status.…”

Pulmonary ground-glass opacity: computed tomography features, histopathology and molecular pathology

“…Transl Lung Cancer Res 2017;6(1):68-75 tlcr.amegroups.com of any GGO (43,44,48) or GGO ratio (33). One study (45) revealed that KRAS mutations were more common in lesions with a lower GGO proportion.…”