Value of CT features for predicting EGFR mutations and ALK positivity in patients with lung adenocarcinoma

Abstract

The aim of this study was to identify the relationships of epidermal growth factor receptor (EGFR) mutations and anaplastic large-cell lymphoma kinase (ALK) status with CT characteristics in adenocarcinoma using the largest patient cohort to date. In this study, preoperative chest CT findings prior to treatment were retrospectively evaluated in 827 surgically resected lung adenocarcinomas. All patients were tested for EGFR mutations and ALK status. EGFR mutations were found in 489 (59.1%) patients, and ALK positivity was found in 57 (7.0%). By logistic regression, the most significant independent prognostic factors of EGFR effective mutations were female sex, nonsmoker status, GGO air bronchograms and pleural retraction. For EGFR mutation prediction, receiver operating characteristic (ROC) curves yielded areas under the curve (AUCs) of 0.682 and 0.758 for clinical only or combined CT features, respectively, with a significant difference (p < 0.001). Furthermore, the exon 21 mutation rate in GGO was significantly higher than the exon 19 mutation rate(p = 0.029). The most significant independent prognostic factors of ALK positivity were age, solid-predominant-subtype tumours, mucinous lung adenocarcinoma, solid tumours and no air bronchograms on CT. ROC curve analysis showed that for predicting ALK positivity, the use of clinical variables combined with CT features (AUC = 0.739) was superior to the use of clinical variables alone (AUC = 0.657), with a significant difference (p = 0.0082). The use of CT features for patients may allow analyses of tumours and more accurately predict patient populations who will benefit from therapies targeting treatment.

Clinicopathologic Features and Molecular Biomarkers as Predictors of Epidermal Growth Factor Receptor Gene Mutation in Non-Small Cell Lung Cancer Patients

“…The study of non-squamous NSCLC patients who received surgical resection, which evaluated clinicopathologic features of EGFR mutation, suggested that lymphatic permeation was lower in tumors harboring EGFR mutations (37.0% vs. 41.9%, p < 0.001) [ 22 ]. In a study involving 827 ADC patients, EGFR mutation was related to a low frequency of lymph node metastasis ( p = 0.006) [ 35 ]. As for the different EGFR mutation subtypes, patients with 19-Del (13.6%) suffered from a higher risk of lymph node metastasis than with wild-type (9.1%) and L858R (5.6%), although with no statistical difference ( p = 0.119) [ 36 ].…”

Molecular typing of lung adenocarcinoma with computed tomography and CT image-based radiomics: a narrative review of research progress and prospects

“…In our index, the Area under curve (AUC) values of conventional CT images for predicting EGFR mutation status were mostly lower than 0.8 ( 46 , 51 , 59 ). Moreover, studies have showed that conventional CT imaging features of lung adenocarcinoma combined with clinical variables could better classify EGFR mutation status than clinical variables alone ( 25 , 53 , 59 ). In Liu et al ’s study, the use of clinical variables combined with conventional CT imaging features (AUC =0.778) was superior to the use of clinical variables alone (AUC =0.690) ( 25 ).…”

“…Studies have shown that ALK rearrangement is common in young patients with lung adenocarcinoma, and lesions with ALK rearrangement are shown as solid nodules on CT images (51)(52)(53)60,(86)(87)(88)(89). The use of clinical variables combined with CT imaging features was superior to the use of clinical variables alone (51,53,59) in predicting the ALK mutation status in lung adenocarcinoma. Conventional CT fimaging eatures can identify ALK-positive lung adenocarcinoma with reasonably strong accuracy (88).…”

“…Most have shown that GGOs and smaller tumour volumes are the most prominent imaging features of lung adenocarcinoma with EGFR mutations than wild-type EGFR mutations (25,(46)(47)(48)(49)(50)(51)(52)(53)(54)(55). In lung adenocarcinoma with different EGFR mutation substyles, lesions with exon 19 deletion and exon 21 L858R substitution are related to a higher GGO proportion than other mutation substyles, and the viewpoints that which of the two has higher GGO proportion are inconsistent in different studies (47,50,(56)(57)(58)(59). In our index, the Area under curve (AUC) values of conventional CT images for predicting EGFR mutation status were mostly lower than 0.8 (46,51,59).…”

“…In lung adenocarcinoma with different EGFR mutation substyles, lesions with exon 19 deletion and exon 21 L858R substitution are related to a higher GGO proportion than other mutation substyles, and the viewpoints that which of the two has higher GGO proportion are inconsistent in different studies (47,50,(56)(57)(58)(59). In our index, the Area under curve (AUC) values of conventional CT images for predicting EGFR mutation status were mostly lower than 0.8 (46,51,59). Moreover, studies have showed that conventional CT imaging features of lung adenocarcinoma combined with clinical variables could better classify EGFR mutation status than clinical variables alone (25,53,59).…”