Non-cancerous CT findings as predictors of survival outcome in advanced non-small cell lung cancer patients treated with first-generation EGFR-TKIs

Q: What was the study purpose in advanced NSCLC patients?

To identify non-cancerous factors from baseline chest CT that affect survival in advanced non-small cell lung cancer patients treated with first-generation EGFR-TKIs.

Q: How were patients and CT parameters assessed?

A retrospective study of 172 advanced NSCLC patients treated with first-line first-generation EGFR-TKIs assessed multiple CT-derived indicators including fat compartments, sarcopenia, myosteatosis, main pulmonary artery (MPA) size/MPA-to-aorta ratio, emphysema, and bone mineral density.

Q: Which baseline CT findings predicted poor survival at 18 months?

Enlarged MPA size and low total adiposity, including low subcutaneous fat measures (lower SAT, lower SATI, and higher VSR), predicted poor survival. MPA size >29 mm or total adiposity ≤85 cm² alone predicted 18-month death.

Sep 23, 2026

Uploaded by Emma Wilson

Purpose, methods, and outcomes identify baseline chest CT predictors for survival in advanced non-small cell lung cancer treated with first-generation EGFR-TKIs. A retrospective cohort of 172 patients (January 2012 to September 2022) evaluated visceral/subcutaneous fat, sarcopenia, myosteatosis, main pulmonary artery size and ratio, emphysema, and bone mineral density. Cox regression assessed prognostic factors for 18-month survival, showing several adiposity and pulmonary artery measures associated with mortality, while sarcopenic and myosteatotic parameters did not differ between groups.

LanguageEnglish

CategoryHealthcare

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Pages16

Reading Time40 min

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Abstract

Purpose

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OPEN ACCESS Citation: Prakaikietikul P, Tajarenmuang P, Losuriya P, Ina N, Ketpueak T, Kanthawang T (2025) Non-cancerous CT findings as predictors of survival outcome in advanced non-small cell lung cancer patients treated with first-generation EGFR-TKIs. PLoS ONE 20(2): e0313577 . [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0313577 Editor: Mirosława Püsküllüoğlu, Maria Sklodowska-Curie National Research Institute of Oncology Krakow, POLAND Received: June 6, 2024 Accepted: October 26, 2024 Published: February 05, 2025 Copyright: © 2025 Prakaikietikul et al. This isan open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data availability statement: All relevant data are within the manuscript and its Supporting Information files. Funding: This research was partially supported by Chiang Mai University. RESEARCH ARTICLE Non-cancerous CT findings as predictors of survival outcome in advanced non-small cell lung cancer patients treated with firstgeneration EGFR-TKIs Pakorn Prakaikietikul1, Pattraporn Tajarenmuang2, Phumiphat Losuriya2, Natee Ina3 , Thanika Ketpueak4, Thanat Kanthawang1* 1 Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 2 Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 3 Radiological Technology Division, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand, 4 Division of Oncology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand * [thanatkanthawang@gmail.com](thanatkanthawang@gmail.com) Abstract Purpose To identify non-cancerous factors from baseline CT chest affecting survival in advanced non-small cell lung cancer (NSCLC) treated with first-generation Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs) . Methods Retrospective study of 172 advanced NSCLC patients treated with first-generation EGFRTKIs as a first-line systemic treatment (January 2012 to September 2022) . Baseline CT chest assessed visceral/subcutaneous fat (L1 level), sarcopenia, and myosteatosis (multiple levels), main pulmonary artery (MPA) size, MPA to aorta ratio, emphysema, and bone mineral density. Cox regression analyzed prognostic factors at 18-month outcome. Results Median overall survival was 17.57 months (14 .87–20. 10) with 76 (44 . 19%) patients died at 18 months. Deceased had lower baseline BMI (21.10 ± 3.44) vs. survived (23 .25 ± 4.45)(p < 0.001) . Univariable analysis showed 5 significant prognostic factors: low total adiposity with/without cutoff [HR 2.65 (1.68–4.18), p < 0.001; 1.00 (0.99–1.00), p = 0.006;], low subcutaneous adipose tissue (SAT) with/without cutoff [HR 1.95 (1.23–3. 11), p = 0.005; 0.99 (0 .98–0.99), p = 0.005], low SAT index (SATI) with/without cutoff [1.74 (1.10–2.78), p = 0.019; 0.98 (0.97–0.99), p = 0.003], high VSR [1.67 (1.06–2.62), p = 0.026], and high MPA size with/without cutoff [2 .23 (1.23–4.04), p = 0.005; 1.09 (1.04–1. 16), p = 0.001] . MPA size, MPA size > 29 mm, and total adiposity ≤85cm2 remained significant in multivariable analysis, adjusted by BMI [HR 1.14 (1.07–1.21), p < 0.001; 3.10 (1.81–5.28), p < 0.001; 3.91 PLOS ONE | [https://doi.org/10.1371/journal.pone.0313577](https://doi.org/10.1371/journal.pone.0313577) February 05, 2025 1 / 16 Competing interests: The authors have declared that no competing interests exist. (1.63–9.40), p = 0.002]. There was no significant difference of sarcopenic and myosteatotic parameters between the two groups. Conclusion In advanced EGFR-mutated NSCLC patients, assessing pre-treatment prognosis is warranted to predict the survival outcome and guide decision re

FAQs

What was the study purpose in advanced NSCLC patients?

To identify non-cancerous factors from baseline chest CT that affect survival in advanced non-small cell lung cancer patients treated with first-generation EGFR-TKIs.

How were patients and CT parameters assessed?

A retrospective study of 172 advanced NSCLC patients treated with first-line first-generation EGFR-TKIs assessed multiple CT-derived indicators including fat compartments, sarcopenia, myosteatosis, main pulmonary artery (MPA) size/MPA-to-aorta ratio, emphysema, and bone mineral density.

Which baseline CT findings predicted poor survival at 18 months?

Enlarged MPA size and low total adiposity, including low subcutaneous fat measures (lower SAT, lower SATI, and higher VSR), predicted poor survival. MPA size >29 mm or total adiposity ≤85 cm² alone predicted 18-month death.

Sep 23, 2026

Uploaded by Emma Wilson