IA期周围型肺腺癌的CT特征与EGFR基因突变的相关性研究  

Correlation between CT features and EGFR gene mutations inpatients with stage IA peripherallung adenocarcinoma

作　　者：康铮 张磊[1] 谢晓东[1] 沈文荣 KANG Zheng;ZHANG Lei;XIE Xiaodong;SHEN Wenrong(Department of Radiology,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]南京医科大学附属肿瘤医院(江苏省肿瘤医院江苏省肿瘤防治研究所)影像科

出　　处：《中国肿瘤外科杂志》2019年第6期415-419,共5页Chinese Journal of Surgical Oncology

基　　金：江苏省卫生计生委科学研究项目(H201509)

摘　　要：目的探讨ⅠA期周围型肺腺癌的CT特征与表皮生长因子受体(EGFR)基因突变的相关性。方法收集2016年1月至2017年12月南京医科大学附属肿瘤医院58例ⅠA期肺癌患者资料,经手术证实为周围型肺腺癌,共68个病灶。回顾性分析其CT特征和临床资料,研究其与EGFR基因突变相关的危险因素。结果 EGFR基因突变型占63.2%,依据高分辨率CT图像中结节的密度将病灶分为3组:肺内纯磨玻璃密度结节(PGGN)、部分实性结节(PST)、实性结节(ST)。3组图像与EGFR突变的相关性分析显示差异有统计学意义(P<0.05),PST组EGFR突变比例较高(32/44个,72.7%),ST组EGFR突变比例较低(2/7个,28.6%);但不能够预测EGFR突变亚型,L858R点突变和第19外显子缺失突变的各组比例相似(P>0.05)。EGFR突变阳性的病灶直径(1.86 cm±0.82 cm)较EGFR野生型(1.42 cm±0.61 cm)的要大、空气支气管征的出现率增多(58.1%vs. 20.0%),差异均有统计学意义(均P<0.05);胸膜牵拉、深分叶及微血管征在EGFR突变的病灶中出现的比例较野生型EGFR高,但差异无统计学意义。结论 IA期周围型肺腺癌患者中,PST、病灶的大小及含空气支气管征的结节与EGFR突变具有相关性,结合其他有意义的CT征象,可为EGFR突变情况提供重要信息,为临床精准医疗的开展提供决策支持。Objective To investigate the correlations between computed tomography(CT) features and epidermal growth factor receptor(EGFR) gene mutations in patients with stage IA peripheral lung adenocarcinoma. Methods CT features and clinical data of 58 patients(68 lesions)with stage IA peripheral lung adenocarcinoma confirmed by surgery were retrospectively analyzed. Risk factors associated with EGFR gene mutations were determined by T test or chi-square test. Results EGFR mutations were found in 43(63.2%) of 68 lesions. According to the density of nodules in high-resolution CT images, the lesions were divided into three groups: pure ground glass density nodules(PGGN), partial solid tumors(PST) and solid tumors(ST). The correlation between the three groups of images and EGFR mutations showed significant differences(P=0.047). And the proportionof EGFR mutations was highest(72.7%) in PST group,lowest(28.6%)in ST group. Whereas, the subtypes of EGFR mutations could not be predicted. There was no significant difference between the mutations proportion of L858 R and deletion of exon 19 in three groups(P=0.714). The diameter of lesions with positive EGFR mutation was larger than that of wild type EGFR([1.86±0.82]cm vs.[1.42±0.61]cm, P=0.014), and the incidence of air bronchial sign was also increased(58.1% vs. 20.0%), which were showed significantly differences(P=0.002).The proportions of pleural traction, deep lobulation and microvascular were higher in the lesions with EGFR mutations than thoseof wild type EGFR, but there were no statistical differences(P>0.05). Conclusions PST, nodules size and air bronchial sign correlation with the mutations of EGFR in IA stage of lung adenocarcinoma patients. Combined with other meaningful CT signs, EGFR mutations of lung adenocarcinoma could be predicted, which would bring benefits to the clinic.

关 键 词：肺腺癌 表皮生长因子受体 CT特征 相关性研究 诊断 

分 类 号：R73[医药卫生—肿瘤]