早期肺腺癌患者高分辨率CT特征对表皮生长因子受体基因突变的预测价值  

Value of HRCT features in predicting epidermal growth factor receptor mutation in early lung adenocarcinoma

作　　者：王丹云 杨旭东 彭忠民[3] Wang Danyun;Yang Xudong;Peng Zhongmin(Department of General Thoracic Surgery,Jinan Center Hospital Affiliated Shandong University,Jinan,250013,China;Department of General Thoracic Surgery,Qianfoshan Hospital Affiliated Shandong University,Jinan,250021,China;Department of General Thoracic Surgery,Shandon provincial Hospital Affiliated Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属济南市中心医院普胸外科,250013 [2]山东大学附属千佛山医院胸外科,250021 [3]山东大学附属省立医院普胸外科,济南250021

出　　处：《中华胸部外科电子杂志》2019年第2期97-105,共9页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的 探讨早期肺腺癌患者高分辨率CT(HRCT)特征对表皮生长因子受体(EGFR)基因突变的预测价值。方法 收集经手术治疗的早期肺腺癌患者208例。采用扩增阻滞突变系统(ARMS)法检测EGFR热点突变基因(18、19、20、21外显子)的突变情况。将患者临床资料、组织病理学结果、HRCT特征纳入数据库。采用χ 2检验以及Fisher精确概率法分析EGFR基因突变与患者临床特征的关系,利用多变量Logistic模型分析EGFR基因突变与患者HRCT特征的相关性。应用Logistic回归模型对有统计学意义的临床和HRCT特征进行多因素分析;绘制EGFR基因突变的受试者工作特征曲线(ROC曲线),计算相应的曲线下面积(AUC)。结果 208例早期肺腺癌中EGFR基因突变98例(47.16%),且多见于女性( P =0.008)、非吸烟( P =0.006)、贴壁为主型腺癌( P =0.032)的患者。HRCT特征中,EGFR基因突变多见于病变含有磨玻璃影(GGO)( P =0.018)和空泡征/空气支气管征( P =0.003)。多因素分析结果显示,非吸烟、贴壁为主型腺癌及病变含有GGO和空泡征/空气支气管征是EGFR基因突变的独立影响因子;ROC曲线分析结果显示,AUC为0.746( P <0.001)。结论 早期肺腺癌HRCT特征中含有GGO及空泡征/空气支气管征与EGFR基因突变相关,临床病理特征结合HRCT特征有助于预测EGFR基因突变。Objective To retrospectively analyze the high resolution CT(HRCT) features and epidermal growth factor receptor(EGFR) mutation of early lung adenocarcinoma after surgical resection, and to explore the value of predicting EGFR mutation by HRCT features in early lung adenocarcinoma. Methods The detailed data of 208 patients with early lung adenocarcinoma who underwent surgical resection were retrospectively analyzed. The mutation of EGFR hotspot mutation gene (exon 18, 19, 20, 21) was detected by amplification refractory mutation system(ARMS), and the CT features of EGFR gene mutation and tumor chest imaging were compared.. SPSS20.0 statistical analysis software was used to establish a database of clinical data, histopathological features and chest CT features. Chi-square test and Fisher’s exact probability test were used to analyze the correlation between patients’ EGFR mutation and their clinical features. Multivariate logistic model was used to analyze the correlation between EGFR mutation and CT features of lung adenocarcinoma. Logistic regression model was used to analyze the clinical and CT features with statistical differences. Relative risk (OR) and 95% confidence interval (CI) were calculated. The ROC curve of EGFR mutation in lung adenocarcinoma was drawn and the corresponding area under the curve (AUC) was calculated. When P < 0.05 , it indicated the difference was statistically significant. Results There were 98 cases (47.16%) of EGFR mutation in 208 cases of lung adenocarcinoma. The mutation of EGFR gene was predominant in female ( P = 0.008), non-smoking ( P =0.006) and adherent adenocarcinoma ( P = 0.032). In chest CT features, EGFR gene mutations were predominant in lesions with ground-glass opacity(GGO)( P =0.018) and vacuole sign/air bronchial sign ( P =0.003). Multivariate analysis showed that non-smoking, adherent-predominant adenocarcinoma and GGO and vacuole/air bronchial sign were independent factors for EGFR mutation. In the multiple logistic regression model, the area under the four com

关 键 词：肺腺癌 高分辨率CT 表皮生长因子受体 磨玻璃影 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]