EGFR突变转化型晚期小细胞肺癌或神经内分泌癌的病理表型时空异质性

Spatial and temporal heterogeneity of pathological phenotype of EGFR-mutant transformed locally advanced or metatsatic small-cell lung cancer or neuroendocrine carcinoma

目的探索表皮生长因子受体(EGFR)突变转化型局部晚期或转移性小细胞肺癌(SCLC)、神经内分泌癌(NEC)的病理表型时空异质性。方法回顾性收集曾接受EGFR-TKIs治疗并转化为SCLC/NEC的LUAD患者,总结首次转化后的基线临床病理特征。根据首次确诊SCLC/NEC转化的病理成分不同而定义为不完全转化和完全转化。针对不完全转化定义为3大类:瘤内不完全转化、瘤间不完全转化和恶性积液不完全转化。结果该研究收集49例符合入组标准的患者。在49例患者中,不完全转化为34.7%(17/49),完全转化为65.3%(32/49)。此外,不完全转化患者中瘤内不完全转化、瘤间不完全转化和恶性积液不完全转化分别为82.3%(14/17)、5.9%(1/17)和11.8%(2/17)。即首次转化的转化型SCLC/NEC的病理表型空间异质性为34.7%。在首次转化后的动态组织学活检和(或)细胞学活检中的15例患者中,转化型SCLC/NEC的病理表型时间异质性为46.7%(7/15)。此外,不完全转化组与完全转化组的转化后无进展生存期差异无统计学意义以及转化后的总生存期差异也无统计学意义。结论EGFR突变转化型局部晚期或转移性SCLC/NEC在病理表型方面存在时空异质性。

Objective To explore the spatial and temporal heterogeneity of pathological phenotype of epidermal growth factor receptor(EGFR)-mutant transformed locally advanced or metastatic small-cell lung cancer(SCLC)or neuroendocrine carcinoma(NEC).Methods This study retrospectively analyzed EGFR-mutant LUAD patients who were treated with EGFR-TKIs and underwent a transformation into SCLC/NEC.Baseline clinicopathological characteristics after initial transformation were summarized.According to the different pathological components of initial SCLC/NEC transformation,it was defined as incomplete transformation and complete transformation.Incomplete transformation was defined as three categories:intratumoral transformation,intertumoral transformation and effusional transformation.Results This study collected 49 patients who met the criteria.Among forty-nine patients,incomplete transformation was 34.7%(17/49)and complete transformation was 65.3%(32/49).In addition,intratumoral transformation,intertumoral transformation and effusional transformation were respectively 82.3%(14/17),5.9%(1/17)and 11.8%(2/17).It was mean that the spatial heterogeneity of pathological phenotype of initially transformed SCLC/NEC was 34.7%.After initial transformation,among the fifteen patients in dynamic histological and/or cytological biopsies,the temporal heterogeneity of pathological phenotype of initially transformed SCLC/NEC was 46.7%(7/15).In addition,there was no significant difference in first-line treatment post-transformation progression-free survival and post-transformation overall survival between incomplete transformation group and complete transformation group.Conclusion EGFR-mutant transformed locally advanced or metaststic SCLC/NEC has spatial and temporal heterogeneity in pathological phenotype.