Choroidal metastases are the most common eye metastatic site. The prevalence of choroidal metastases in NSCLC patients has been reported to vary from 0.2 to 7% in historical series. Although previously reported, little is known about choroidal metastasis in Epidermal Growth Factor Receptor (EGFR)-mutant Non-small cell lung cancer (NSCLC). This study sought to describe the prevalence of choroidal metastases among patients with EGFR-mutated NSCLC and their characteristics, and to estimate their impact on prognosis. We conducted a single-center retrospective study including all consecutive metastatic EGFR-mutant NSCLC patients, from Sept. 2015 to Oct. 2018. The EGFR-mutant NSCLC patients were identified via the Department of Genetics’ files. Patients who exhibited choroidal metastases were compared to patients without choroidal metastases. Kaplan-Meier analysis and log-rank test were conducted to assess median overall survival (OS) from diagnosis for the two groups. The study was approved by the IRB as CEPRO number #2020–010. Prevalence of choroidal metastases in EGFR-mutated NSCLCs was 8.4% (7/83). Five were women, and four current or former smokers. Molecular analysis showed three tumors with exon 19 deletion, three with L858R mutation, and one with complex exon 21 mutation. The choroidal metastases were symptomatic in six/seven patients. Visual disturbances decreased in all but one symptomatic cases upon EGFR TKI, and the choroidal response was maintained over time. Median follow-up was 42.2 mo (95%CI [37.2–47.1]). Median OS in the choroidal metastasis group was 23.4 mo (95%CI [0.1–51.4]) versus 27.9 mo (95%CI [16.9–38.9]) in the non-choroidal metastasis group (p = 0.32). In the choroidal metastasis group, 2-year and 5-year OS were 47.6 and 0%, respectively, versus 55.8 and 26.3% in the non-choroidal metastasis subset. Choroidal metastases in NSCLC EGFR-mutant patients are rare but should be systematically suspected in case of visual disturbance. TKIs are efficient for treating visual symptoms. Whether choroidal metastases confer a worse prognosis remains unclear owing to the third-generation EGFR TKI osimertinib first-line registration.

中文翻译：

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表皮生长因子受体突变的非小细胞肺癌和脉络膜转移：长期结果和对表皮生长因子受体酪氨酸激酶抑制剂的反应

脉络膜转移瘤是最常见的眼转移部位。据报道，NSCLC患者脉络膜转移的发生率在历史系列中为0.2％至7％。尽管以前已有报道，但对于表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）中的脉络膜转移了解甚少。本研究试图描述EGFR突变型NSCLC患者脉络膜转移的发生率及其特征，并评估其对预后的影响。我们从2015年9月至2018年10月进行了一项包括所有连续转移性EGFR突变NSCLC患者的单中心回顾性研究。通过遗传学部的档案鉴定了EGFR突变NSCLC患者。将表现出脉络膜转移的患者与没有脉络膜转移的患者进行比较。进行了Kaplan-Meier分析和对数秩检验以评估两组诊断后的中位总生存期（OS）。该研究被IRB批准为CEPRO号2020-010。EGFR突变的NSCLCs中脉络膜转移的发生率为8.4％（7/83）。五名是妇女，四名目前或以前的吸烟者。分子分析显示，三个外显子19缺失的肿瘤，三个外显子L858R突变和一个复杂的外显子21突变。6/7例患者的脉络膜转移瘤是有症状的。在除EGFR TKI以外的所有有症状病例中，视觉障碍均减少，并且脉络膜反应随时间而得以维持。中位随访时间为42.2 mo（95％CI [37.2–47.1]）。脉络膜转移组的中位OS为23.4 mo（95％CI [0.1-51.4]），而非脉络膜转移组为27.9 mo（95％CI [16.9-38.9]）（p = 0.32）。在脉络膜转移组中，2年和5年OS分别为47.6和0％，而非脉络膜转移组为55.8和26.3％。NSCLC EGFR突变患者的脉络膜转移很少见，但如果出现视觉障碍，应系统地怀疑。TKI对治疗视觉症状有效。由于第三代EGFR TKI osimertinib一线注册，脉络膜转移是否赋予更差的预后尚不清楚。