Early and late brain metastases in EGFR wild type and EGFR mutation positive non small cell lung cancer: Implications for survival.
Bibliographic record
Abstract
e19065 Background: EGFR mutation positivity (EGFR+) is a known favorable prognostic factor in NSCLC. We sought to understand its significance in the setting of brain metastases (BM) when compared to EGFR wild type (WT) patients. We evaluated the difference between early versus late BM ( < = 6 vs > 6 months from diagnosis) in EGFR+ and WT patients with respect to radiographic patterns and the impact on overall survival (OS). Methods: A retrospective study was conducted in patients with stage IV non-squamous NSCLC and known EGFR mutation status who underwent whole brain radiotherapy or surgical resection of BM from Mar 2010 - Dec 2012 at British Columbia Cancer Agency. The data was divided into WT and EGFR+ patients, early and late BM groups to characterize the radiographic patterns and OS from initial NSCLC diagnosis (dx) and BM dx. Results: A cohort of 430 patients was composed of 327 WT (206 early vs 121 late) and 103 EGFR+ (65 early vs 38 late). Pattern of BM in WT showed more frequent leptomeningeal disease in late compared to early BM (8% vs. 2%, p = 0.01) and no difference in size of largest BM, number of metastases or cerebral edema. Pattern of BM in EGFR+ showed a trend towards a miliary pattern in late BM (p = 0.058) and no difference in size of largest BM, cerebral edema or leptomeningeal spread. Median OS from initial dx in EGFR WT was early: 7.1 m vs. late: 24.9 m (p < 0.001) and OS from BM dx was 6.3 m vs. 4.9 m respectively (p = 0.67). Median OS from initial dx in EGFR+ was early: 19.9 m vs. late: 25.6 m (p = 0.39) and OS from BM dx early: 19.2 m vs. late: 3.9 m (p < 0.001). The Cox proportional hazards model including sex, age, PS, systemic treatment and BM timing showed that early BM were associated with poor survival outcomes in the EGFR WT patients, while it did not impact survival in EGFR+ patients. Conclusions: OS in EGFR+ patients is comparable between early and late BM, suggesting EGFR positivity and associated EGFR tyrosine kinase inhibitor treatment are stronger prognostic and predictive factors for survival than BM. In contrast, early BM is a significant negative prognostic indicator for survival in EGFR WT patients. The radiographic pattern of BM is different between WT and EGFR+ patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".