非小细胞肺癌临床及CT影像特征与EGFR基因突变的相关性研究  

Study on correlation between clinical and CT imaging features and EGFR gene mutation in non-small cell lung cancer

作　　者：杨燕[1] 黑忠林[1] 田兴仓[2] 白雪红[1] 陈俊杰[1] 赵仁[1] Yang Yan;Hei Zhonglin;Tian Xingcang;Bai Xuehong;Chen Junjie;Zhao Ren(Department of Radiotherapy,General Hospital of Ningxia Medical University,Yinchuan 750001,China;Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750001,China)

机构地区：[1]宁夏医科大学总医院放疗科,银川750001 [2]宁夏医科大学总医院放射科,银川750001

出　　处：《肿瘤研究与临床》2025年第3期167-171,共5页Cancer Research and Clinic

基　　金：宁夏医科大学校级科研项目(XM2020140)。

摘　　要：目的探讨非小细胞肺癌(NSCLC)患者临床及CT影像特征与表皮生长因子受体(EGFR)基因突变的相关性及预测突变指标的筛选。方法回顾性病例对照研究。回顾性分析2015年1月至2019年12月宁夏医科大学总医院经病理证实且治疗前行胸部增强CT检查及EGFR基因检测的178例NSCLC患者的临床资料,按照基因检测结果将患者分为EGFR基因突变组和未突变组,比较两组患者临床及CT影像特征;采用多因素logistic回归模型筛选NSCLC患者EGFR基因突变的独立影响因素。结果178例NSCLC患者中,EGFR基因突变115例(64.6%),未突变63例(35.4%)。115例EGFR基因突变患者中,第19号外显子缺失(19del)突变61例(53.0%)、第21号外显子L858R突变45例(39.1%)、第20号外显子突变8例(7.0%)、第18号外显子突变1例(0.9%)。EGFR基因突变组女性[60.0%(69/115)比30.2%(19/63)]、无吸烟史[74.8%(86/115)比36.5%(23/63)]患者比例均高于未突变组,差异均有统计学意义(均P<0.001),两组不同病理类型及临床分期的患者比例比较,差异均无统计学意义(均P>0.05)。EGFR基因突变组CT检查的中位肿瘤长径[M(Q1,Q3)]为3.70(2.90,4.70)cm,未突变组为5.30(3.40,6.80)cm,差异有统计学意义(Z=-3.66,P<0.001);EGFR基因突变组有空气支气管征[27.8%(32/115)比7.9%(5/63)]、无肺气肿[83.5%(96/115)比55.6%(35/63)]患者比例均高于未突变组,差异均有统计学意义(均P<0.01)。多因素logistic回归分析结果显示,无吸烟史(有比无:OR=0.218,95%CI:0.073~0.647)、CT检查肿瘤长径短(OR=0.814,95%CI:0.676~0.981)、有空气支气管征(有比无:OR=5.354,95%CI:1.782~16.090)及无肺气肿(有比无:OR=0.289,95%CI:0.128~0.653)为NSCLC患者EGFR基因突变的独立危险因素(均P<0.05)。结论临床及CT影像特征与NSCLC患者EGFR基因突变状态可能相关,无吸烟史及CT检查中肿瘤长径短、有空气支气管征、无肺气肿可能预示EGFR突变。Objective To explore the correlation between clinical and CT imaging features and epidermal growth factor receptor(EGFR)gene mutation in patients with non-small cell lung cancer(NSCLC)and screening of mutation prediction indicators.Methods A retrospective case-control study was conducted.The clinical data of 178 NSCLC patients who were confirmed by pathology and underwent pre-treatment chest-enhanced CT scan and EGFR gene mutation testing in General Hospital of Ningxia Medical University from January 2015 to December 2019 were retrospectively analyzed.Patients were classified into EGFR mutation-positive and mutation-negative groups based on genetic testing results,and the clinical and CT imaging features were compared between the two groups;the multivariate logistic regression model was used to identify the independent influencing factors for EGFR gene mutation in NSCLC patients.Results Among 178 NSCLC patients,115 cases(64.6%)were EGFR gene mutation-positive and 63 cases(35.4%)were mutation-negative.Among the 115 EGFR gene mutation-positive patients,there were 61 cases(53.0%)of exon 19 deletion(19del)mutation,45 cases(39.1%)of exon 21 L858R mutation,8 cases(7.0%)of exon 20 mutation,and 1 case(0.9%)of exon 18 mutation.The proportions of female patients[60.0%(69/115)vs.30.2%(19/63)]and patients with out smoking history[74.8%(86/115)vs.36.5%(23/63)]in EGFR gene mutationpositive group were higher than those in the mutation-negative group,and the differences were statistically significant(both P<0.001),while the proportions of patients with different pathological types and clinical stages in the two groups showed no statistically significant differences(both P>0.05).The median maximum diameter of tumor[M(Q1,Q3)]detected by CT in the EGFR gene mutationpositive group was 3.70(2.90,4.70)cm,while in the mutation-negative group it was 5.30(3.40,6.80)cm,and the difference was statistically significant(Z=-3.66,P<0.001).The proportions of patients with air bronchogram[27.8%(32/115)vs.7.9%(5/63)]and without emphysema[83.5%(96

关 键 词：癌 非小细胞肺 受体 表皮生长因子 突变 体层摄影术 螺旋计算机 

分 类 号：R734.2[医药卫生—肿瘤]