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Prognostic potential of initial CT changes for progression-free survival in gefitinib-treated patients with advanced adenocarcinoma of the lung: a preliminary analysis

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We aimed to determine whether initial tumour responses measured during short-term follow-up computed tomography (CT) examinations after baseline examinations would correlate with clinical outcomes in patients with non-small cell lung cancer (NSCLC) who received epidermal growth factor receptor (EGFR)-targeted therapy.

Methods

A total of 86 gefitinib-treated patients with advanced adenocarcinoma of the lung were retrospectively reviewed. All patients underwent baseline and short-term follow-up CT examinations. The new response criteria (NRC) by Lee et al. were used for the response evaluations. A Cox proportional hazards multiple regression model and Kaplan–Meier survival analyses were used to evaluate correlations between the initial tumour changes and progression-free and overall survival (PFS, OS).

Results

Better separation and smaller p values were observed for both PFS and OS when good and poor disease responses (as defined by NRC) were compared after excluding tumours with characteristic morphologies. Early tumour changes correlated with PFS in a size-dependent manner. Moreover, a stronger association was observed between size changes and PFS when characteristic morphology was also considered.

Conclusions

Initial changes in tumour size during short-term post-treatment CT examinations could act as a potential prognostic imaging surrogate for PFS in gefitinib-treated patients with advanced adenocarcinoma of the lung.

Key points

• Initial responses to gefitinib on computed tomography significantly correlate with clinical outcomes.

• Regardless of morphology, size decrease greater than 30 % predicts prolonged progression-free and overall survival.

• Combination of size and morphological changes yields prognostic independence regarding progression-free survival.

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Abbreviations

CECT:

contrast-enhanced CT

CI:

confidence intervals

CR:

complete response

CT:

computed tomography

ECOG PS:

Eastern Cooperative Oncology Group Performance Status

EGFR:

epidermal growth factor receptor

EMR:

electronic medical records

HR:

hazard ratio

LD:

longest dimension

NRC:

new response criteria

NSCLC:

non-small cell lung cancer

OS:

overall survival

PD:

progressive disease

PFS:

progression-free survival

PR:

partial response

RECIST 1.1:

Response Evaluation Criteria in Solid Tumors, version 1.1

SD:

stable disease

TDR:

tumour decrease rate

TKI:

tyrosine kinase inhibitor

VEGF:

vascular endothelial growth factor

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Acknowledgments

The authors thank the Cancer Registry Group of Tri-Service General Hospital for the help with the clinical data. The scientific guarantor of this publication is Hsian-He Hsu. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. No study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gong Road, Nei-Hu, Taipei, 114, Taiwan, Republic of China

    Yu-Cheng Wu, Hsian-He Hsu, Wei-Chou Chang, Kai-Hsiung Ko & Yi-Chih Hsu

  2. Department of Healthcare Administration, Asia University, Taichung, Taiwan, Republic of China

    Ho-Jui Tung

  3. Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Tsai-Wang Huang & Hung Chang

  4. Division of hematology-oncology, Department of internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Ching-Liang Ho

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  1. Yu-Cheng Wu
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Correspondence to Hsian-He Hsu.

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Wu, YC., Hsu, HH., Chang, WC. et al. Prognostic potential of initial CT changes for progression-free survival in gefitinib-treated patients with advanced adenocarcinoma of the lung: a preliminary analysis. Eur Radiol 25, 1801–1813 (2015). https://doi.org/10.1007/s00330-014-3579-x

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  • DOI: https://doi.org/10.1007/s00330-014-3579-x

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