双能量CT、CEA、CA125在预测EGFR-TKIs治疗EGFR突变型肺腺癌疗效的临床价值  

Clinical value of dual-energy CT,CEA and CA125 in predicting the effect of EGFR-TKIs on EGFR mutant lung adenocarcinoma

作　　者：宋芹霞 王祥发 胡汉金 史恒峰[1] 刘静[2] 何实[2] SONG Qinxia;WANG Xiangfa;HU Hanjin;SHI Hengfeng;LIU Jing;HE Shi(Department of Medical Imaging,Anqing Municipal Hospital,Anhui Medical University,Anqing,Anhui Province 246000,China;Department of Pneumology,Anqing Municipal Hospital,Anhui Medical University,Anqing,Anhui Province 246000,China)

机构地区：[1]安徽医科大学附属安庆市立医院医学影像科,安徽安庆246000 [2]安徽医科大学附属安庆市立医院呼吸科,安徽安庆246000

出　　处：《实用放射学杂志》2023年第3期379-383,共5页Journal of Practical Radiology

基　　金：安徽医科大学2019年度校科研基金资助项目(2019xkj233)。

摘　　要：目的探讨双能量CT(DECT)定量参数、肿瘤标志物CEA、CA125在预测酪氨酸激酶抑制剂(TKIs)治疗表皮生长因子受体(EGFR)突变型肺腺癌患者疗效的临床价值。方法收集66例行DECT增强检查的EGFR突变型肺腺癌患者的临床及影像资料,根据实体瘤疗效评价标准1.1版(RECIST1.1)分为有效组和无效组,比较2组之间临床资料、DECT定量参数值及肿瘤指标差异,使用Logistic回归分析靶向治疗疗效,记录无进展生存期(PFS)。结果EGFR 19外显子缺失39例,EGFR 21外显子突变27例,有效组静脉期碘浓度(IC_(VP))、静脉期标准化碘浓度(NIC_(VP))、静脉期能谱曲线斜率(k_(VP))均高于无效组(1.76±0.52 vs 1.40±0.47、0.34±0.09 vs 0.24±0.07、2.44±0.46 vs 1.90±0.40,P<0.05),有效组CEA、CA125高于无效组(78.46±52.02 vs 21.96±13.06、186.46±129.35 vs 42.96±25.56,P<0.05)。IC_(VP)、NIC_(VP)、k_(VP)、CEA、CA125预测进展期肺腺癌靶向治疗疗效的曲线下面积(AUC)分别为0.708、0.818、0.811、0.767、0.804,各参数联合AUC为0.977。根据受试者工作特征(ROC)曲线计算IC_(VP)、NIC_(VP)、k_(VP)、CEA、CA125最佳截断值分别为1.52 mg/mL、0.28、2.15、33.5 ng/mL、54.5 U/mL。Cox分析显示EGFR突变类型、k_(VP)、CA125与PFS独立相关,PFS在EGFR 19外显子缺失与EGFR 21外显子突变分别为15.2、10.9个月,k_(VP)≥2.15与k_(VP)<2.15为13.9、9.7个月,CA125≥54.5 U/mL与CA125<54.5 U/mL为13.6、8.5个月。结论IC_(VP)、NIC_(VP)、k_(VP)、CEA、CA125能够预测EGFR突变型肺腺癌EGFR-TKIs靶向治疗疗效。以上指标联合可显著提高预测效能。Objective To evaluate the clinical value of dual-energy CT(DECT)quantitative parameters,tumor marker CEA and CA125 in predicting the efficacy of tyrosine kinase inhibitors(TKIs)in treating lung adenocarcinoma with epidermal growth factor receptor(EGFR)mutant.Methods The clinical and imaging data of 66 patients with EGFR mutant lung adenocarcinoma were col-lected.The patients were divided into the response group and the non-response group according to response evaluation criteria in solid tumors version 1.1(RECIST1.1).The clinical data,DECT quantitative parameters and tumor markers were compared between the two groups.Logistic model was used to evaluate the predictors of targeted therapy response,and progression-free survival(PFS)was recorded.Results There were 39 cases with EGFR 19 exon deletion and 27 cases with EGFR 21 exon mutant.Intravenous iodine concentration(IC_(VP)),normalized iodine concentration(NIC_(VP)),and k(k_(VP))in the response group were higher than those in the non-response group(1.76±0.52 vs 1.47±0.47,0.34±0.09 vs 0.24±0.07,2.44±0.46 vs 1.90±0.40,P<0.05).CEA and CA125 in the response group were higher than those in the non-response group(78.46±52.02 vs 21.96±13.06,186.46±129.35 vs 42.96±25.56,P<0.05).The area under the curve(AUC)of IC_(VP),NIC_(VP),k_(VP),CEA and CA125 were 0.708,0.818,0.811,0.767 and 0.804,respectively.When combined them,AUC was 0.977.The optimal values of IC_(VP),NIC_(VP),k_(VP),CEA and CA125 were 1.52 mg/mL,0.28,2.15,33.5 ng/mL,and 54.5 U/mL,respectively.Cox analysis showed the type of EGFR mutation,k_(VP),and CA125 were associated with PFS independently.PFS were 15.2 and 10.9 months in the EGFR 19 exon deletion and EGFR 21 exon mutant,13.9 and 9.7 months in the k_(VP)≥2.15 and k_(VP)<2.15,13.6 and 8.5 months in the CA125≥54.5 U/mL and CA125<54.5 U/mL.Conclusion IC_(VP),NIC_(VP),k_(VP),CEA and CA125 can predict the therapeutic efficacy of EGFR-TKIs in treatment of EGFR mutant lung adenocarcinoma.Prediction efficiency can improved significantly when combined the

关 键 词：酪氨酸激酶抑制剂 肿瘤标志物 肺腺癌 无进展生存期 计算机体层成像 

分 类 号：R44[医药卫生—诊断学]