Different Clinicopathologic and Computed Tomography Imaging Characteristics of Primary and Acquired EGFR T790M Mutations in Patients with Non-Small-Cell Lung Cancer

Abstract

Purpose Although patients with primary and acquired epidermal growth factor receptor (EGFR) T790M positive non-small-cell lung cancer (NSCLC) respond to osimertinib treatment, the optimal treatment strategy differs for these two groups of patients. This study aimed to compare the clinicopathologic and computed tomography (CT) imaging characteristics between primary and acquired EGFR T790M mutations in patients with NSCLC before treatment. Patients and Methods We enrolled two groups of patients with primary or acquired EGFR T790M mutation NSCLC (n = 103 per group) from January 2012 to December 2019. We analyzed their clinicopathologic and CT characteristics and differences between the groups. The groups were further categorized based on 21L858R and 19del to exclude the effect of coexistent mutations. Results Primary, compared to acquired, T790M mutation tends to coexist with 21L858R (P < 0.001), exhibiting earlier tumor stage (P < 0.001), higher differentiation (P = 0.029), higher proportion of lepidic subtype adenocarcinoma (P < 0.001), and significant associations with some CT features (multiple primary lung cancers, ground-glass opacity, air bronchogram, and vacuole sign [all P < 0.001]). The combined model, composed of clinicopathologic and conventional CT signature and CT-radiomic signature, showed good discriminative ability with the area under the receiver operating characteristic curve 0.90 and 0.91 in the training and validation datasets, respectively. The T790M mutation contributed to these differences independently of coexistent mutations. Conclusion We identified clinicopathologic and CT imaging differences between primary and acquired T790M mutations. These findings provide insights into developing future personalized T790M mutation status-based theranostic strategies.

Editorial for “Preoperative MRI‐Based Radiomics of Brain Metastasis to Assess T790M Resistance Mutation After EGFR‐TKI Treatment in NSCLC”

“…Findings from a previous study by Hou et al have demonstrated that textural features can be used for the identification of primary as well as acquired T790 mutations, and the present study also reported similar results. 8 Also, the present study reported that textural features were more predictive of secondary mutations. The present study also had limitations in terms of being a singlecenter study and only utilizing T1CE and T2W MRI sequences.…”

Preoperative MRI‐Based Radiomics of Brain Metastasis to Assess T790M Resistance Mutation After EGFR‐TKI Treatment in NSCLC

“…These results are also partially supported by Hou et al who suggested textural features from CT images can be used to distinguish between primary and acquired EGFR T790M mutations in patients with NSCLC. 38 Limitations First, this study was retrospective and comprised a relatively small sample size. A multi-center, prospective clinical trial with a larger sample size will be required to verify our findings.…”

Aumolertinib Effectively Reduces Clinical Symptoms of an EGFR L858R-Mutant Non-Small Cell Lung Cancer Case Coupled With Osimertinib-Induced Cardiotoxicity: Case Report and Review

“…Lung cancer is one of the most common malignancies and the leading cause of cancer-associated deaths worldwide ( 11 ). About 15% of Caucasian and nearly 50% of Asian advanced NSCLC patients were detected with EGFR-positive mutation, mostly in exons 18–21 ( 12 , 13 ).…”