PET/CT中^(18)F-FDG摄取值联合血清CEA水平预测肺腺癌EGFR突变的价值  

^(18)F-FDG uptake in PET/CT combined with serum CEA level for predicting EGFR mutation in patients with lung adenocarcinoma

作　　者：王运 朱红洲[2] 高心逸 嵇建峰 庞伟强[1] 易贺庆[1] 靳水 龙斌[1] 吴红霞[1] 叶雪梅[1] 李林法[1] WANG Yun;ZHU Hongzhou;GAO Xinyi;JI Jianfeng;PANG Weiqiang;YI Heqing;JIN Shui;LONG Bin;WU Hongxia;YE Xuemei;LI Linfa(Department of Nuclear Medicine,Zhejiang Cancer Hospital,Hangzhou 310022,China;不详)

机构地区：[1]浙江省肿瘤医院核医学科,杭州310022 [2]浙江省肿瘤医院放射科,杭州310022

出　　处：《浙江医学》2023年第17期1830-1835,共6页Zhejiang Medical Journal

基　　金：浙江省基础公益研究计划(LGF19H160010);浙江省医药卫生科技计划项目(2021KY563、2023KY068)。

摘　　要：目的探讨正电子发射型计算机断层显像(PET)/CT中氟18-脱氧葡萄糖(^(18)F-FDG)摄取值联合血清癌胚抗原(CEA)水平预测肺腺癌表皮生长因子受体(EGFR)突变的价值。方法选取2016年12月至2020年4月在浙江省肿瘤医院治疗前接受血清CEA水平、EGFR突变检测并行PET/CT检查的肺腺癌患者196例,采用EGFR基因突变检测试剂盒检测EGFR突变。分析EGFR突变与患者临床特征、原发肿瘤^(18)F-FDG最大标准化摄取值(SUV_(max))、血清CEA水平及CT影像学特征的关系。采用二元logistic回归分析影响肺腺癌患者EGFR突变的因素。ROC曲线评估PET/CT中^(18)F-FDG SUV_(max)联合血清CEA水平预测EGFR突变的效能。结果196例患者中,EGFR突变型109例(55.6%),EGFR野生型87例(44.4%)。单因素分析显示,EGFR突变型患者女性比例、无吸烟史比例、血清CEA水平≥5 ng/mL比例、无毛刺比例均高于EGFR野生型患者,而肿瘤直径、^(18)F-FDG SUV_(max)均低于EGFR野生型患者,差异均有统计学意义(均P<0.05)。多因素分析显示,^(18)F-FDG SUV_(max)<12.8、血清CEA水平≥5 ng/mL、肿瘤直径较小、无毛刺是影响EGFR突变的独立预测因素(均P<0.05)。ROC曲线分析显示,^(18)F-FDG SUV_(max)、^(18)F-FDG SUV_(max)联合CEA水平、肿瘤直径、边缘无毛刺的AUC分别为0.613和0.754。结论^(18)F-FDG SUV_(max)联合CEA水平、肿瘤直径、有无毛刺助于预测肺腺癌患者的EGFR突变状态,特别是当肿瘤样本不足以进行基因分析或无法进行基因检测时。Objective To investigate^(18)F-FDG uptake in PET/CT combined with serum CEA level for predicting EGFR mutation status in patients with lung adenocarcinoma.Methods One hundred and ninety-six patients with lung adenocarcinoma admitted from December 2016 to April 2020 in Zhejiang Cancer Hospitl were enrolled in the study.All patients underwent FDG PET/CT examination,EGFR mutation testing and serum CEA analysis.The associations of EGFR mutations with the _(max)imum standardized uptake value(SUV_(max))of primary tumors,serum CEA level and CT imaging features were analyzed with binary logistic regression.Receiver operating characteristic(ROC)curve analysis was performed to analyze the predictive value of these factors for EGFR mutation.Results Among 196 patients,EGFR mutation was identified in 109 cases(55.6%)and EGFR wild type was identified in 87 cases(44.4%).Univariate analysis showed that the proportion of female patients,no smoking history,serum CEA level≥5 ng/mL and non spiculated margin in CT imaging in patients with EGFR mutation were higher;and the tumor diameter and^(18)F-FDG SUV_(max) were lower than those in patients with EGFR wild type(all P<0.05).Multivariate logistic analysis showed that SUV_(max)<12.8 and serum CEA level≥5 ng/mL,smaller tumor size and non spiculated margin in CT imaging were the independent predictors of EGFR mutation(all P<0.05).The AUC values of^(18)F-FDG SUV_(max) alone and SUV_(max) in combination with CEA level,tumor size and tumor margin for predicting EGFR mutations were 0.613 and 0.754,respectively.Conclusion The combination of^(18)F-FDG uptake,CEA level,tumor size and tumor margins may be helpful in predicting EGFR mutation status in patients with lung adenocarcinoma,especially when the tumor sample is inadequate for genetic analysis or genetic testing is not available.

关 键 词：肺腺癌 氟18-脱氧葡萄糖 表皮生长因子受体 癌胚抗原 

分 类 号：R734.2[医药卫生—肿瘤]