Abstract:
Background:The epidermal growth factor receptor (EGFR) gene has been identified as the driving gene of non-small cell lung cancer (NSCLC), and EGFR-tyrosine kinase inhibitor (TKI) has shown efficacy, but acquired resistance is inevitable. It has been confirmed that the secondary EGFR Thr790Met (T790M) mutation accounts for about 50% of the mechanisms of acquired resistance to EGFR-TKI. The third-generation of EGFR-TKI has significantly efficacy in advanced T790M-positive NSCLC patients. Therefore, it is necessary to detect the status of T790M in patients with acquired resistance after first generation EGFR-TKI. The objective of this study was to investigate the positive rate of plasma test T790M mutation and its relationship with different clinical characteristics, and the frequency of T790M mutation in advanced EGFR-mutant NSCLC patients with acquired resistance after firstline EGFR-TKI treatment. Methods:Patients from a single clinical center (Taizhou hospital) were recruited prospectively from September 2017 to June 2018. The eligibility criteria of the trial included the following: (I) aged 18 years or older, histologically confirmed NSCLC stage IIIB/st and EGFR mutation positive; (II) progressive disease (PD) after first generation EGFR-TKI by RECIST v1.1, with PFS>3 months; (III) no third generation TKI treatment. All patients signed informed consent, had 10 mL of blood drawn, and were evaluated for the presence of T790M gene by amplification refractory mutation system (ARMS). The study was approved by the Ethics Committee of Taizhou Hospital (ethical batch number: 201637). Results:A total of 189 patients were included in the analysis. The overall T790M mutation rate of plasma detection was 36.51% (69/189). The positive rate of T790M mutation after the failure of first generation EGFR-TKI treatment was not correlated with the patient's age, sex, and the type of first generation TKI drugs. However, it was related to the mutation type of EGFR in baseline and the mode of progression according to reports by Wu et al. The frequency of T790M mutation among patients with initial exon 19 deletion mutation, exon 21 L858R point mutation, and other mutations were 45.45%, 26.19% and 33.33%, respectively. The mutation rate of T790M in 19del mutant patients was higher than that of L858R mutation and other mutations (P=0.026). The frequency of T790M mutation in local progression patients was 50% after the first generation TKI was resistant to drug treatment: in gradual progression it was 26.92%, and in dramatic progression it was 38.10%. The frequency of T790M mutation of patients with local progression was significantly higher (P=0.031). Conclusions:The patients with EGFR mutations after the first generation of EGFR-TKI-acquired resistance of NSCLC were evaluated for their plasma EGFR mutation status, and the overall T790M mutation rate of was 36.51%. The frequency of T790M mutation with initial mutation of 19 del was higher than that of L858R mutation and other mutations, and local progression was higher than that in patients with gradual progression and dramatic progression.
journal_name
J Thorac Disjournal_title
Journal of thoracic diseaseauthors
Li H,Wang J,Zhang G,Li Y,Lin L,Yang H,Zhou J,Zhang L,Lv Ddoi
10.21037/jtd.2019.12.122subject
Has Abstractpub_date
2020-03-01 00:00:00pages
550-557issue
3eissn
2072-1439issn
2077-6624pii
jtd-12-03-550journal_volume
12pub_type
杂志文章abstract:Background:Human rhinovirus (HRV) is one of the most common viral etiologies detected in community-acquired pneumonia (CAP) adult cases. However, few is known about the characteristics of HRV-associated CAP. To describe the clinical features of HRV-associated CAP in immunocompetent adults admitted to multiple medical c...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2017.10.107
更新日期:2017-11-01 00:00:00
abstract::Congenital pericardial defects are a rare anomaly, found during autopsy and cardiothoracic surgery. We describe a case of a 69-year-old female, with a right-sided congenital pericardial defect associated with a giant bronchogenic cyst (BC) found during surgery. The cyst was resected and the patient developed arrhythmi...
journal_title:Journal of thoracic disease
pub_type:
doi:10.21037/jtd.2016.06.65
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:The aim of the present study was to identify specious radiologic and/or physiologic prognostic marker(s), which lead to optimize of the patient follow-up frequency. METHODS:Eighty consecutive patients with newly diagnosed pulmonary sarcoidosis. Patients underwent chest radiography, high-resolution computed ...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2017.01.17
更新日期:2017-01-01 00:00:00
abstract:Background:Consolidation durvalumab improved overall survival (OS) in locally advanced non-small cell lung cancer (LA-NSCLC) treated with chemoradiotherapy (CRT) in the PACIFIC trial; however, pneumonitis was increased with durvalumab. We sought to examine real-world outcomes with the PACIFIC paradigm, especially facto...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd-20-1792
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:For patients diagnosed with locally advanced esophageal cancer, neoadjuvant therapy followed by surgery is the most common approach. However, randomized trials resulted in inconsistent conclusions. We conducted this retrospective study to evaluate the influence of neoadjuvant therapy on postoperative events ...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2017.02.19
更新日期:2017-02-01 00:00:00
abstract::In 2011, three authoritative academic communities, International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society (IASLC/ATS/ERS), published a novel lung adenocarcinoma histologic classification. The major modifications of this classification include the abo...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.3978/j.issn.2072-1439.2014.09.15
更新日期:2014-10-01 00:00:00
abstract:Background:Trans-subxiphoid thoracoscopic thymectomy is a promising procedure but technically demanding associated with ergonomic discomfort. In order to facilitate this complex procedure, the authors present a modified trans-subxiphoid thymectomy by the use of the Da Vinci robotic system. Methods:A 2-cm longitudinal ...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2018.03.07
更新日期:2018-03-01 00:00:00
abstract::Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable and inoperable lung cancer ...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.3978/j.issn.2072-1439.2015.09.40
更新日期:2015-09-01 00:00:00
abstract:Background:In this retrospective study, we aimed to compare single-port (SP) and two-port (TP) video-assisted thoracic surgery (VATS) for the surgical resection of mediastinal tumor. Methods:Between December 2015 and October 2018, a total of 191 consecutive mediastinal tumor patients who underwent SP- or TP-VATS in th...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2019.11.05
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use. METHODS:A cost-effectiveness study was performed comparing VATS vs...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2017.07.51
更新日期:2017-08-01 00:00:00
abstract:Background:Primary ciliary dyskinesia (PCD) is an inherited ciliary motility disorder caused by mutations in at least 40 genes. RSPH9 gene mutations encoding aberrant radial spoke head proteins have been linked with PCD. The clinical spectrum extent of RSPH9 gene mutations remains to date largely unknown. We aimed to d...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2019.04.71
更新日期:2019-05-01 00:00:00
abstract::We report a case involving a female patient with primary hyperparathyroidism arising from a middle mediastinal parathyroid adenoma. Initial diagnosis was made based on a history of polyuria and recurrent renal colic. At the age of 77 she underwent videoscopic assisted mediastinoscopy (VAM) for resection of the adenoma...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2016.08.87
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:The importance of the role of bronchial arteries is notable in modern days thoracic surgery. The significance of their anastomoses with adjusted structures has not yet been sufficiently rated, especially in cases of haemoptysis, heart-lung transplantations and treatment of aneurysms of the thoracic aorta. Th...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.3978/j.issn.2072-1439.2014.09.32
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:A clinical trial of extracorporeal membrane oxygenation (ECMO) as an alternative ventilator tool is being performed as a new indication for ECMO. The purpose of this study was to evaluate the feasibility of awake ECMO to increase the success rate of weaning patients from ECMO and ventilator care during treat...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.3978/j.issn.2072-1439.2016.01.32
更新日期:2016-01-01 00:00:00
abstract:Background:The detection rate of ground-glass opacity (GGO) in young patients has increased year by year with the increasingly widespread use of high-resolution computed tomography (HRCT) and the increased resolution of HRCT imaging. However, no scholars have reported the clinical characteristics and prognosis of GGO i...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2019.01.32
更新日期:2019-02-01 00:00:00
abstract::During recent years, continuous technological innovation has provoked an increase of extracorporeal life support (ECLS) use for perioperative cardiopulmonary support in lung transplantation. Initial results were disappointing, due to ECLS-specific complications and high surgical risk of the supported patients. However...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2018.07.43
更新日期:2018-08-01 00:00:00
abstract:Background:Pacing parameters may influence pacing lead life and pacemaker life. This study sought to determine whether different right atrial active-fixation lead implantation parameters are associated with chronic pacing performance. Methods:A retrospective observational study was conducted on all consecutive patient...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2019.04.04
更新日期:2019-04-01 00:00:00
abstract::The severity of the clinical condition and co-morbidities of the patients for esophagectomy require a complex assessment and risk stratification before the operation, and most of the cases need complex management. We did a literature search and considered the data on risk stratification and complex management of patie...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2018.12.11
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVE:Double lung point is a rare sign of pneumothorax in clinical practice. In this report I presented an 18-month-old child who presented with bilateral pneumothorax. DATA SYNTHESIS AND CASE PRESENTATION:Ultrasonography examination revealed conventional lung point sign on the right and double lung point on the l...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.3978/j.issn.2072-1439.2015.01.14
更新日期:2015-03-01 00:00:00
abstract:Background:The primary objective of the study was to evaluate the health-related quality of life (HRQL) of patients with benign post-intubation tracheal stenosis considered as unfit for surgical treatment. Secondary objectives were: (I) to determine if clinical variables (gender, age, total treatment time, and type of ...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2018.07.80
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Concurrent chemoradiotherapy (CRT) with 5-fluorouracil (5-FU) and cisplatin (CDDP) are often associated with significant incidence of toxic effects in elderly patients with esophageal cancer. This phase I trial was designed to determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of S-1...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2016.02.70
更新日期:2016-03-01 00:00:00
abstract::The vascular structure related compression of esophagus is rather rare. Aberrant right subclavicular artery accounts for the majority of the rare entity, while the thoracic aorta aneurysm is a more dangerous type, called as dysphagia aortica. Delay in diagnosis and treatment of the dysphagia aortica predisposes to rup...
journal_title:Journal of thoracic disease
pub_type:
doi:10.3978/j.issn.2072-1439.2013.11.15
更新日期:2013-12-01 00:00:00
abstract:Background:Small pulmonary nodules have been detected frequently by computed tomography (CT). Lung cancers with cavity formation are also easily detected. There are a few reports focused on the cavity wall, although cancer cells exist along the cavity wall, not inside. We evaluated the impact of cavity wall thickness o...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2018.01.61
更新日期:2018-02-01 00:00:00
abstract:Background:Although emphysema and small cell lung cancer (SCLC) are prevalent in smokers, no previous study has investigated the prognostic impact of computed tomography (CT)-determined emphysema in SCLC. This study was undertaken to analyze the prognostic value of emphysema scores as determined by baseline CT scans in...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2018.01.97
更新日期:2018-02-01 00:00:00
abstract:Background:To investigate the epidemiological characteristics of 11 atypical pathogens of community-acquired pneumonia (CAP) among Chinese, and to determine whether or not there is an association between these pathogens and the severity of illness. Methods:We conducted a surveillance study for CAP in 30 hospitals of B...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2018.10.50
更新日期:2018-11-01 00:00:00
abstract::Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.3978/j.issn.2072-1439.2013.11.08
更新日期:2014-03-01 00:00:00
abstract::Post pneumonectomy bronchopleural fistula (BPF) is a life-threatening complication requiring pleural cavity drainage to avoid acute mediastinal shift and contralateral aspiration pneumonia. Chest drain insertion in this situation may be technically difficult because of drastic anatomical changes such as mediastinal di...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2017.11.145
更新日期:2018-01-01 00:00:00
abstract::Pathologic diagnosis of thymic tumors (TTs) can be made by surgical or nonsurgical procedures. About 20% of TTs had been diagnosed by pretreatment biopsy methods while the rest had gone to surgery for diagnosis and treatment. However, in the last two decades there was an increase in pretreatment procedures for optimal...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd-2019-thym-14
更新日期:2020-12-01 00:00:00
abstract::The left internal mammary artery (LIMA) to the left anterior descending artery bypass remains the gold standard for coronary artery bypass grafting. This review focuses on the three major options for LIMA takedown when using minimal access options to achieve this bypass, namely standard minimally invasive direct coron...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.3978/j.issn.2072-1439.2013.11.02
更新日期:2013-11-01 00:00:00
abstract:Background:Non-small cell lung cancer (NSCLC) harboring EGFR-sensitizing mutations has a distinct biology and heterogeneous clinical behavior. We evaluated the characteristics to progression such as clinical patterns of progression (dramatic, gradual, and local) with the prognosis of NSCLC patients treated with tyrosin...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2018.03.106
更新日期:2018-04-01 00:00:00