摘要
目的分析肺腺癌表皮生长因子(EGFR)基因外显子19及21突变患者的临床、病理及CT特征。方法回顾性分析2012年12月至2020年12月重庆医科大学附属第一医院肺腺癌患者683例的临床、病理及影像资料。其中男性351例, 女性332例, 年龄25~89(62±11)岁。根据基因突变状态分为EGFR基因常见位点突变(外显子19、21突变)382例(突变组), 包括外显子19突变者165例(外显子19突变亚组), 外显子21突变者217例(外显子21突变亚组), 及EGFR基因无突变301例(无突变组)。突变组与无突变组、外显子19突变亚组与外显子21突变亚组各特征的比较采用独立样本t检验和χ^(2)检验。将单因素分析差异有统计学意义的指标纳入二元logistic回归分析筛选出独立预测因子并构建模型。以受试者操作特征曲线及曲线下面积(AUC)评估模型或指标的预测效能。结果突变组与无突变组肺腺癌患者的性别分布、吸烟史、实体生长方式为主占比、周围型分布、肿瘤最大径(3 cm为截点)分布、毛刺征、磨玻璃密度影、充气支气管征、血管集束征、胸膜凹陷征及肺内转移灶数目(10个为截点)、胸腔积液、坏死、胸内淋巴结转移差异有统计学意义(P<0.05)。logistic回归分析示女性(OR=5.230, 95%CI 3.534~7.740, P<0.001)、无吸烟史(OR=2.970, 95%CI 1.986~4.443, P<0.001)、磨玻璃密度影(OR=3.092, 95%CI 1.746~5.477, P<0.001)、无坏死(OR=1.754, 95%CI 1.047~2.939, P=0.033)、血管集束征(OR=3.129, 95%CI 1.971~4.969, P<0.001)、胸膜凹陷征(OR=2.434, 95%CI 1.680~3.526, P<0.001)及肺内转移灶≥10个(OR=2.242, 95%CI 1.284~3.915, P=0.005)为肺腺癌EGFR基因外显子21及19突变的独立预测因素, 以其构建的logistic模型预测肺腺癌EGFR基因外显子21及19突变的AUC为0.804。EGFR基因外显子19突变亚组与外显子21突变亚组的性别分布、腺泡状为主生长方式占比、周围型分布、血管集束征及胸膜凹陷征差异有统计学意义(P<0.05)。logistic回归分析示血管集束征(OR=1.833, 95%CI 1.187~2.831, P=0.006)是预测肺腺癌EGFR基因外显子21突变的独立危险因素, 其鉴别腺癌EGFR基因外显子21突变与外显子19突变的AUC为0.604。结论肺腺癌EGFR常见位点突变与无突变、EGFR基因外显子19与外显子21突变患者的临床、病理及CT特征均存在一定差异, 熟悉和掌握这些差异, 有助于基因突变状态未知型肺腺癌患者的个体化治疗。
Objective To investigate the clinical,pathological and CT characteristics of lung adenocarcinoma patients with epidermal growth factor receptor(EGFR)19 and 21 exon mutations.Methods Clinical,pathological and imaging data of 683 patients with lung adenocarcinoma in the First Affiliated Hospital of Chongqing Medical University from December 2012 to December 2020 were retrospectively analyzed.According to the gene mutation status,patients were divided into EGFR common loci mutation group(exons 19 or 21)with 382 cases(mutation group),including 19 exon mutation in 165 cases(exon 19 mutation subgroup)and 21 exon mutation in 217 cases(exon 21 mutation subgroup),and EGFR negative mutation group with 301 cases(negative mutation group).Independent sample t-test andχ^(2) test were used to compare those features between mutation group and negative mutation group,exon 19 mutation subgroup and exon 21 mutation subgroup.The indicators with statistically significant differences in univariate analysis were included in binary logistic regression analysis to screen out independent predictors and establish the model.Receiver operating characteristic curve and area under curve(AUC)were used to evaluate the predictive performance of the model or index.Results There were significant differences between mutation group and negative mutation group in gender distribution,smoking history,the proportion of solid-dominated growth pattern,peripheral distribution,tumor maximum diameter(3 cm as the cut-off point)distribution,spiculation,ground-glass opacity(GGO),air bronchogram,vascular convergence sign,pleural retraction,the number of lung metastases(10 as the cut-off point),pleural effusion,necrosis,and lymph node metastasis in lung adenocarcinoma patients(P<0.05).The logistic regression showed that female(OR=5.230,95%CI 3.534-7.740,P<0.001),non-smoking history(OR=2.970,95%CI 1.986-4.443,P<0.001),GGO(OR=3.092,95%CI 1.746-5.477,P<0.001),absence of necrosis(OR=1.754,95%CI 1.047-2.939,P=0.033),vascular convergence sign(OR=3.129,95%CI 1.971-4.969,P<0.001),pleural retraction(OR=2.434,95%CI 1.680-3.526,P<0.001),and the number of lung metastases≥10(OR=2.242,95%CI 1.284-3.915,P=0.005)were independent predictors of EGFR exon 19 and 21 mutations,and the AUC of the logistic model based on these predictors in predicting EGFR exon 21 and 19 mutations in lung adenocarcinoma was 0.804.There were significant differences between EGFR exon 19 mutation subgroup and EGFR 21 mutation subgroup in gender distribution,the proportion of acinar-dominated growth pattern,peripheral distribution,vascular convergence sign,pleural retraction(P<0.05).The logistic regression showed that vascular convergence sign(OR=1.833,95%CI 1.187-2.831,P=0.006)was independent predictor of EGFR exon 21,the AUC of vascular convergence sign for distinguishing EGFR exon 19 and EGFR 21 mutation was 0.604.Conclusions There are some differences in the clinical,pathological,and CT features of patients between EGFR common loci mutation and EGFR negative mutations,EGFR exon 19 and exon 21 mutations in lung adenocarcinoma.Familiarity with these differences is helpful for the individualized treatment of patients with unknown gene mutation status of lung adenocarcinoma.
作者
霍继文
李琦
罗天友
吕发金
Huo Jiwen;Li Qi;Luo Tianyou;Lyu Fajin(Department of Radiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2023年第2期142-149,共8页
Chinese Journal of Radiology
基金
重庆市医学科研项目(2022MSXM147)
重庆市人才计划创新领军人才研究项目(CQYC20210303348)
重庆市科技局项目(cstc2022ycjh-bgzXM0230)。
关键词
腺癌
肺
体层摄影术
X线计算机
表皮生长因子受体
Adenocarcinoma
Lung
Tomography,X-ray computed
Epidermal growth factor receptor
