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Features and prognostic impact of distant metastasis in patients with stage IV lung adenocarcinoma harboring EGFR mutations: importance of bone metastasis

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Abstract

Mutated epidermal growth factor receptor (EGFR) and signaling pathways were associated with multiple brain and intra-pulmonary metastases, oncogenic progression and metastasis. However, features of metastasis to other organs and the independent prognostic influence of metastatic lesions were not elucidated in patients with lung cancer harboring EGFR mutations. Between January 2007 and April 2012, we treated 277 patients diagnosed with stage IV lung adenocarcinoma. Studied were 246 patients with available tumor EGFR mutation data who also underwent radiographic evaluation of lung, abdominal, brain, and bone metastases. The EGFR mutated group (N = 98) had significantly more metastatic lesions in the brain and bone than the wild-type group (N = 148): brain, 3 (1–93) versus 2 (1–32) median (range), P = 0.023; bone, 3 (1–43) versus 2 (1–27), P = 0.035, respectively. In addition, EGFR mutations were significantly more frequent in patients with multiple than non-multiple lung metastases (24/40 vs. 12/42, P = 0.004). Multivariate analysis showed that bone metastasis was a significant independent negative predictive factor of overall survival (OS) in patients with mutated [hazard ratio (HR) 2.04; 95 % confidence interval (CI) 1.17–3.64; P = 0.011] and wild-type EGFR (HR 2.09; 95 % CI 1.37–3.20; P < 0.001). In conclusion, patients with mutated EGFR had more lung, brain, and bone metastases, and bone metastasis was an independent negative predictor of OS.

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Acknowledgments

This study was supported by internal funding and the Ethics Committee of Kobe City Medical Center General Hospital. The authors would like to thank Keiko Sakuragawa for her administrative assistance.

Conflict of interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan

    Daichi Fujimoto, Ryoko Shimizu, Ryoji Kato, Takehiro Otoshi, Takahisa Kawamura, Koji Tamai, Yumi Shibata, Takeshi Matsumoto, Kazuma Nagata, Kyoko Otsuka, Atsushi Nakagawa, Kojiro Otsuka, Nobuyuki Katakami & Keisuke Tomii

  2. Department of Radiology, Kobe City Medical Center General Hospital, Kobe, Japan

    Hiroyuki Ueda

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  1. Daichi Fujimoto
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Correspondence to Daichi Fujimoto.

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Fujimoto, D., Ueda, H., Shimizu, R. et al. Features and prognostic impact of distant metastasis in patients with stage IV lung adenocarcinoma harboring EGFR mutations: importance of bone metastasis. Clin Exp Metastasis 31, 543–551 (2014). https://doi.org/10.1007/s10585-014-9648-3

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  • DOI: https://doi.org/10.1007/s10585-014-9648-3

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