Genetic-pathological prediction for timing and site-specific recurrence pattern in resected lung adenocarcinoma
Genetic-pathological prediction for timing and site-specific recurrence pattern in resected lung adenocarcinoma
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DOI：
10.1093/ejcts/ezab288
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发表时间：
2021-06-25
影响因子：
3.4
通讯作者：
Chen, Haiquan
中科院分区：
文献类型：
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作者：
Deng, Chaoqiang;Zhang, Yang;Chen, Haiquan
目标：我们的目的是准确地描述手术切除肺腺癌的时间和部位特异性复发模式，并开发遗传病理风险预测模型，以指导个体术后监测策略。方法：我们回顾性分析了2008年至2015年1531例肺腺癌切除患者的9种常见致癌驱动突变的放射学，病理学和测序数据。记录首次复发部位和复发时间。独立的危险因素进行了多变量回归分析，从而纳入预测models.RESULTS：平均随访53.2个月，术后复发483例（31.5%）。骨和脑复发倾向于早期发生（中位数分别为11.7和17.0个月），而胸部复发发生较晚（中位数为22.2个月），这在不同的肿瘤分期中得到了验证。EGFR突变是脑和骨复发的独立预测因子，KRAS突变是早期复发的独立预测因子。脑和骨复发预测列线图的内部和外部验证均显示出最佳区分（一致性指数：内部，分别为0.75和0.81;外部，分别为0.77和0.84）和校准。复发发生相对均匀的随访期间，在低风险组，但主要发生在2年内在高危groups.CONCLUSIONS：独特的生物学差异之间存在肺腺癌导致不同的复发模式。这些用户友好的遗传病理列线图可以帮助医生更好地分层患者，并制定个性化的术后随访计划。
OBJECTIVES: We aimed to describe accurately the timing and site-specific recurrence pattern for surgical resected lung adenocarcinoma and develop genetic-pathological risk prediction models to guide individual postoperative surveillance strategies.METHODS: We retrospectively analysed radiological, pathological and sequencing data concerning 9 common oncogenic driver mutations from 1531 patients with resected lung adenocarcinoma between 2008 and 2015. The first recurrence site and time-to-recurrence were recorded. Independent risk factors were identified by multivariable regression analysis and consequently incorporated into prediction models.RESULTS: With a median follow-up of 53.2 months, postoperative recurrences were noted in 483 (31.5%) patients. Bone and brain recurrence tended to occur early (median 11.7 and 17.0 months, respectively) while thorax recurrence occurred later (median 22.2 months), which was validated across different tumour stages. EGFR mutation was an independent predictor for brain and bone recurrence and KRAS mutation for early recurrence. Both internal and external validation of the nomograms for brain and bone recurrence prediction showed optimal discrimination (concordance index: internal, 0.75 and 0.81, respectively; external, 0.77 and 0.84, respectively) and calibration. Recurrence occurred relatively evenly during the follow-up period in low-risk groups but mainly occurred within 2 years in high-risk groups.CONCLUSIONS: Unique biological differences exist among lung adenocarcinoma leading to distinct patterns of recurrence. These user-friendly genetic-pathological nomograms may help physicians to better stratify patients and make individual postoperative follow-up plans.