^(18)F-FDG PET/CT肿瘤内代谢异质性参数预测肺腺癌EGFR基因突变的价值  

Predictive value of intratumoral heterogeneity measured by ^(18)F-FDG PET/CT for EGFR mutation of adenocarcinoma

作　　者：程楠[1] 张谷青[1] 高明[1] 王寻 孔钰 Cheng Nan;Zhang Guqing;Gao Ming;Wang Xun;Kong Yu(Department of Imaging,the Affiliated Hospital of Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院医学影像科,济宁272000

出　　处：《中华核医学与分子影像杂志》2024年第1期1-5,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨18F-FDG PET/CT传统代谢参数、CT征象及肿瘤内代谢异质性参数预测肺腺癌表皮生长因子受体(EGFR)基因突变的价值。方法回顾性纳入2016年1月至2020年6月间在济宁医学院附属医院经病理证实的147例肺腺癌患者[男73例、女74例, 年龄(59.8±10.2)岁], 分析EGFR基因突变组与野生组患者在临床资料(吸烟史、肿瘤位置及临床分期)、CT征象(最大径、有无磨玻璃成分、分叶征、毛刺征、空泡征、空气支气管征、胸膜凹陷征及支气管截断征)、18F-FDG PET/CT传统代谢参数[SUV_(max)、SUV_(mean)、肿瘤代谢体积(MTV)及病灶糖酵解总量(TLG)]及肿瘤内代谢异质性参数[CV、异质性指数(HI)]间的差异。采用两独立样本t检验、Mann-WhitneyU检验或χ^(2)检验分析数据;通过多因素logistic回归分析EGFR基因突变的预测因素;采用ROC曲线分析探讨不同参数对EGFR基因突变的预测效能。结果 147例患者中, EGFR基因突变型87例, EGFR野生型60例。2组患者在性别(男/女)、吸烟史(有/无)、原发灶位置(周围/中心)、胸膜凹陷征(有/无胸膜凹陷征)、SUV_(max)、SUV_(mean)、TLG、CV及HI间的差异均有统计学意义(χ^(2)值:4.72~23.89, z值:-2.31~5.74, 均P<0.05)。多因素logistic回归分析示, 吸烟史[比值比(OR)=0.167, 95%CI:0.076~0.366;P<0.001]、胸膜凹陷征(OR=1.404, 95%CI:1.115~3.745;P=0.012)、SUV_(max)(OR=0.922, 95%CI:0.855~0.995;P=0.003)、TLG(OR=0.991, 95%CI:0.986~0.996;P=0.001)及HI(OR=0.796, 95%CI:0.700~0.859;P<0.001)是EGFR基因突变的预测因素。HI预测EGFR基因突变的AUC为0.779, 灵敏度为76.67%(46/60)、特异性为79.31%(69/87);联合吸烟史、胸膜凹陷征、SUV_(max)、TLG及HI构建EGFR基因突变预测模型, AUC为0.908, 灵敏度为88.33%(53/60)、特异性为68.97%(60/87)。两者ROC AUC的差异有统计学意义(z=3.71, P<0.001)。结论 HI预测肺腺癌EGFR基因突变价值较高, 联合吸烟史、胸膜凹陷征、SUV_(max)、TLG时, 预测能力�Objective To investigate the value of traditional metabolic parameters,CT features and intratumoral heterogeneity parameters measured by 18F-FDG PET/CT in predicting the mutation status of the epidermal growth factor receptor(EGFR)gene in patients with adenocarcinoma.Methods A total of 147 patients(73 males,74 females,age(59.8±10.2)years)with pathological confirmed adenocarcinoma between January 2016 and June 2020 in the Affiliated Hospital of Jining Medical University were retrospectively included.The differences of clinical data(smoking history,tumor location and clinical stage),CT features(maximum diameter,ground-glass opacity content,lobulation,speculation,cavitation,air-bronchogram,pleural retraction and bronchial cut-off sign),18F-FDG PET/CT traditional metabolic parameters(SUV_(max),SUV_(mean),metabolic tumor volume(MTV)and total lesion glycolysis(TLG))and intratumoral heterogeneity parameters(CV,heterogeneity index(HI))were analyzed between patients with EGFR mutation and patients with EGFR wild-type.Independent-sample t test,Mann-Whitney U test andχ^(2) test were used to analyze the data.Multivariate logistic regression was used to analyze the predictors of EGFR mutation.ROC curve analysis was used to evaluate the predictive value of clinical and PET/CT information.Results Among 147 patients,87 were with EGFR mutation and 60 were with EGFR wild-type.There were significant differences in gender(male/female),smoking history(with/without),location(peripheral lesion/central lesion),pleural retraction(with/without),SUV_(max),SUV_(mean),TLG,CV and HI(χ^(2) values:4.72-23.89,z values:from-2.31 to 5.74,all P<0.05).Multivariate logistic regression analysis showed that smoking history(odds ratio(OR)=0.167,95%CI:0.076-0.366;P<0.001),pleural retraction(OR=1.404,95%CI:1.115-3.745;P=0.012),SUV_(max)(OR=0.922,95%CI:0.855-0.995;P=0.003),TLG(OR=0.991,95%CI:0.986-0.996;P=0.001)and HI(OR=0.796,95%CI:0.700-0.859;P<0.001)were predictors of EGFR mutation.ROC curve analysis showed the AUC of HI was 0.779,with the sensitivit

关 键 词：肺肿瘤 腺癌 突变 受体 表皮生长因子 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 

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