Bilateral diffuse metastatic lung adenocarcinoma (BLDM-LUAD) is a special imaging pattern of lung adenocarcinoma (LUAD). We retrospectively assessed survival outcomes and co-mutation characteristics of BLDM-LUAD patients harboring epidermal growth factor receptor (EGFR) mutations who were treated with EGFR-yrosine kinase inhibitors (TKIs). From May 2016 to May 2021, among 458 patients who submitted samples for next generation sequencing (NGS) detection in 1125 patients with non-small-cell lung cancer (NSCLC), and 44 patients were diagnosed as BLDM-LUAD. In order to analyze the survival outcomes of BLDM-LUAD patients harboring EGFR mutations who were treated with EGFR-TKIs, the factors age, gender, smoking history, hydrothorax, site of EGFR mutations and EGFR-TKIs treatment were adjusted using propensity score-matching (PSM). The Kaplan-Meier survival curves and log-rank test were used to analyze progression-free survival (PFS) and overall survival (OS). The co-mutation characteristics of BLDM-LUAD patients harboring EGFR mutations were analyzed by NGS panels. 64 patients with advanced lung adenocarcinoma harboring EGFR mutations and first-line treatment of EGFR-TKIs were successfully matched. BLDM-LUAD (n = 32) have significantly longer median PFS than control group (n = 32) (mPFS: 14 vs 6.2 months; p = .002) and insignificantly longer median OS than control group (mOS: 45 vs 25 months; p = .052). The patients with BLDM-LUAD have the higher frequency of EGFR mutation than control group (84.1% vs 62.0%) before PSM. The co-mutation genes kirsten rat sarcoma viral oncogene homolog (KRAS) (9.4%), ataxia telangiectasia-mutated (ATM) (7.4%) and mesenchymal-epithelial transition (MET) (3.1%) only appeared in the control group after PSM. The BLDM-LUAD harboring EGFR mutations was associated with a favorable prognosis to EGFR-TKI.

中文翻译：

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携带 EGFR 突变的晚期肺腺癌的双侧弥漫性转移与 EGFR-TKI 的良好预后相关

双侧弥漫性转移性肺腺癌（BLDM-LUAD）是肺腺癌（LUAD）的一种特殊影像学表现。我们回顾性评估了接受EGFR酪氨酸激酶抑制剂 (TKI)治疗的携带表皮生长因子受体 ( EGFR ) 突变的 BLDM-LUAD 患者的生存结果和共突变特征。 2016年5月至2021年5月，在1125名非小细胞肺癌（NSCLC）患者中，458名提交样本进行二代测序（NGS）检测的患者中，44名患者被诊断为BLDM-LUAD。为了分析接受EGFR -TKI治疗的携带EGFR突变的 BLDM-LUAD 患者的生存结果，使用倾向评分匹配对年龄、性别、吸烟史、胸水、 EGFR突变位点和EGFR -TKI 治疗等因素进行了调整（PSM）。 Kaplan-Meier生存曲线和时序检验用于分析无进展生存期（PFS）和总生存期（OS）。通过 NGS panel 分析了携带EGFR突变的 BLDM-LUAD 患者的共突变特征。 64例携带EGFR突变的晚期肺腺癌患者与一线EGFR -TKI治疗患者成功匹配。 BLDM-LUAD (n = 32) 的中位 PFS 显着长于对照组 (n = 32)（mPFS：14 个月 vs 6.2 个月；p  = 0.002），中位 OS 也长于对照组（mOS：45 个月 vs 25 个月； p = 0.002）。 p  = .052)。 BLDM-LUAD患者PSM前EGFR突变频率高于对照组（84.1% vs 62.0%）。共突变基因克尔斯滕大鼠肉瘤病毒癌基因同源物（KRAS）（9.4％）、共济失调毛细血管扩张突变（ATM）（7.4％）和间质-上皮转化（MET）（3.1％）仅出现在PSM后的对照组中。携带EGFR突变的 BLDM-LUAD与EGFR -TKI的良好预后相关。