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Background: We investigated the biological predisposition to site of metastasis in patients with NSCLC based on their molecular profiling and program death ligand PD-L1 status. We sought to identify any association between metastatic site and molecular profile in NSCLC patients. Methods: This was a retrospective analysis of patients with stage IV NSCLC who were newly diagnosed from January 2014 to June 2022. Clinical characteristics, pathology, molecular reports, and imaging were retrieved and analyzed. Results: A total of 143 patients were included in the study. Median age was 65 years, with an equal number of men (n=71) and women (n=72). The most common histology was adenocarcinoma (81.8%). At least one genetic mutation was discovered in 100 patients. Mutations with a targetable drug were found in 86 patients. The most common mutations were TP53 (25.2%), EGFR (24.5%), KRAS/NRAS (20.3%), and CDKN2A/2B (7.7%). Patients with any mutation were significantly more likely to have metastatic disease to the brain (57% vs. 37%, p=0.03), but there was no difference in metastatic disease to bone (34% vs. 26%, p=0.32). Patients without a discoverable mutation were significantly more likely to have metastatic disease to other sites (e.g., adrenal gland 91% vs. liver 66%, p=0.002). There was no difference in progression-free survival (PFS) or overall survival (OS) between those with versus without mutations. Median PFS and OS were significantly longer in patients with an EGFR mutation than those with KRAS/NRAS or TP53 mutations. Patients with PD-L1 >1% or TP53 were significantly more likely to have metastatic disease to organs other than bone or brain (p=0.047 and p=0.023, respectively). We identified four prognostic groups in metastatic NSCLC. Patients with PD-L1 <1% and no actionable mutations have the poorest prognosis, with median survival of around 20 months. Conclusion: Patients with mutations discoverable on NGS are more likely to have metastatic disease to the brain. KRAS/NRAS in particular has a predilection to metastasize to the brain and bone. PD-L1 expression and a TP53 mutation, on the other hand, tend to lead to metastasis of NSCLC to organs other than brain or bone. These results need to be corroborated in larger prospective studies.
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OBJECTIVE: This study aimed to observe the value of computed tomography (CT) spectral imaging parameters in the diagnosis of solitary pulmonary nodules, during the contrast-enhanced early phase and late phase. MATERIALS AND METHODS: This study was approved by the institutional review board and written informed consent was obtained from all patients. One hundred thirty-nine patients with solitary pulmonary nodules proved by pathology underwent double-phase enhanced CT scan using gemstone spectral imaging mode on a Discovery CT750 HD, and were divided into an active inflammatory group (43 cases), a malignant group (65 cases), and a tuberculosis group (31 cases). The slope rate was calculated from the spectral curve. Iodine concentrations (ICs) were derived from iodine-based material decomposition CT images and normalized to the IC in the aorta. The Kruskal-Wallis test and Nemenyi test were performed to compare quantitative parameters among the 3 groups or between each of the 2 groups. RESULTS: There were significant differences in the slope rate, IC, and normalized IC (NIC) among the 3 groups. In the active inflammatory group, malignant group, and tuberculosis group, the mean slope rate were 3.03 ± 0.71 (SD), 1.96 ± 0.91, and 1.37 ± 0.43, respectively, during the early phase and 3.28 ± 0.67, 2.24 ± 0.82, and 1.67 ± 0.64, respectively, during the late phase. The ICs were 2.68 mg/mL ± 0.56, 1.65 mg/mL ± 0.76, and 1.10 mg/mL ± 0.34, respectively, during the early phase and 2.79 mg/mL ± 0.57, 1.90 mg/mL ± 0.71, and 1.29 mg/mL ± 0.44, respectively, during the late phase. The NIC were 0.24 ± 0.06, 0.16 ± 0.04, and 0.10 ± 0.04, respectively, during the early phase and 0.57 ± 0.10, 0.43 ± 0.11, and 0.25 ± 0.09, respectively, during the late phase. The mean slope rate, IC, and NIC for the active inflammatory group were significantly higher than these parameters for the malignant group (P < 0.05), and the parameters for malignant group were significantly higher than the tuberculosis group (P < 0.05). CONCLUSIONS: Dual-energy CT gemstone spectral imaging provides a novel method to better characterize pulmonary nodules in double-phase contrast-enhanced scanning.