| ObjectiveThe purpose of this study is to explore the safety and feasibility of lung puncture rebiopsy in non-small cell lung cancer(NSCLC)patients with acquired resistance to epidermal growth factor receptor(EGFR)tyrosine kinase inhibitors(TKI),then analyze the risk factors affecting the incidence of complications.Analyzing the mutation status in patients with acquired resistance to EGFR TKI,we evaluated the clinical factors influencing the incidenceof T790M mutation.MethodsA retrospective study of 186 non-small cell lung cancer patients treated with EGFR-TKI from January 2016 to December 2018 in the first affiliated hospital of Zhengzhou University.Factors related to rebiopsy were analyzed by single and multiple factors.Of 121 patients undergoing EGFR gene testing after resistance to EGFR-TKI therapy were analyzed before and after gene therapy.Univariate and multivariate analyses were performed on the T790M positive and negative groups.ResultsThe average age of 186 patients was 58.0±10.2 years,and adenocarcinoma was more common.The success rate of puncture re-biopsy was 100%,and 72.0%were biopsied at the primary lesion.The average times of punctures was 2.3±1.6.The average depth of lung needles was 2.5 ± 1.8cm.The average time was 14.6 ± 5.5 minutes.The detection rate of malignant cells was 91.4%(170/186).The detection rate of malignant cells was 91.4%(170/186),and inflammatory necrotic cells were more common in non-tumor tissues,accounting for 87.5%(14/16)of failed re-biopsy factors.Four cases of lung adenocarcinomas were transformed into SCLC after EGFR-TKI treatment.The total complications were 79 cases(42.5%),including 42 cases of pneumothorax(22.6%)and 40 cases of pulmonary hemorrhage(21.5%).Three patients had pneumothorax and pulmonary hemorrhage.Univariate analysis of complications revealed gender(P=0.006),smoking history(P=0.002),coaxial cannula device(P=0.077),frequency of puncture needle adjustment(P=0.021),lesion depth(P=0.013),and total biopsy time(P=0.012)was statistically significant(P<0.10);Logistic regression multivariate analysis showed a history of smoking(0R=3.33;95%CI:1.46?7.61;P=0.004),the longer the biopsy time(0R=1.07;95%CI:1.01?1.14;P=0.023),lesion depth ?3cm(0R=2.59;95%CI:1.35?4.96;P=0.004)were complications of re-biopsy in NSCLC patients with acquired resistance to EGFR TKI.The EGFR mutation rate was reduced by 0.8%compared with that before treatment,and 57.9%(70/121)cases had acquired T790M acquired resistance mutations.Compared with disease progression before treatment,the EGFR gene mutation inconsistency rate was 58.7%(71/121),19Del+T790M was the most common,accounting for 42.1%.Univariate analysis for T790M mutation positive patients and T790M mutation negative patients,EGFR mutation status(P=0.003),total duration of EGFR-TKI treatment(P=0.005),frequency of puncture needle adjustment(P=0.040),and total biopsy time(P=0.091)were statistically different(P<0.10).However,re-biopsy timing did not influence the detection rate of T790M mutation(P=0.392);Logistic regression multivariate analysis showed that total duration of EGFR-TKI treatment beyond 10 months(0R=2.55;95%CI:1.16?5.64;P=0.021),19Del mutation(0R=2.58;95%CI:1.17?5.66;P=0.018)were independent risk factors for T790M positive.Conclusion1.CT-Guided lung puncture re-biopsy was feasible and safe in Non-Small Cell Lung Cancer patients with acquired resistance to EGFR tyrosine kinase inhibitors,which can provide sufficient samples for pathological diagnosis and molecular analysis.2.The complications of lung re-biopsy were pneumothorax and hemorrhage and smoking history,re-biopsy time,and lesion depth were independent risk factors for complications of re-biopsy.3.Patients with EGFR exon 19 deletion mutation who receive long-term EGFR-TKI therapy show a high prevalence of T790M mutation.Mutation status changes include changes in T790M mutations,wild-type transformations and changes in pathological types such as SCLC transformations. |
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