周围型小肺腺癌表皮生长因子受体基因突变与高分辨CT、病理亚型的相关性

A comparative study of HRCT and pathological subtype, EGFR gene mutations of peripheral small lung adenocarcinoma

目的 探讨周围型小肺腺癌表皮生长因子受体（EGFR）基因突变类型与术前高分辨CT（HRCT）以及术后病理亚型相关性.方法 北京朝阳医院胸外科2011年12月-2014年11月接受手术切除肺小结节患者156例,其中肺腺癌128例,回顾性分析资料完整的94例浸润性腺癌患者,男37例、女57例,年龄32～ 76岁,平均52.6岁.手术方式为肺叶切除＋系统淋巴结清扫或肺局部切除（楔形或肺段）＋淋巴结清扫.分析指标包括：术前HRCT、术后病理亚型、淋巴结情况;EGFR、Kras、ALK、FGF9基因表达情况.结果 术后病理腺泡为主型占33.0％ （31/94）、乳头状为主型占25.5％ （24/94）、附壁生长型占19.1％ （18/94）、微乳头状为主13.8％ （13/94）、实性为主8.5％（8/94）.7例淋巴结阳性,其中N15例（第11～12组）、N22例（第7组和第4组各1例）.术后病理基因检测EGFR突变36例（38.3％,36/94）,主要为19＋和21＋.与术前HRCT表现相比,EGFR突变与无突变者差异无统计学意义（x2 =1.411,P=0.703）.对于不同EGFR基因突变类型,差异亦无统计学意义（P＞0.05）.但是EGFR 21阳性者多见于肿瘤进展患者,显著高于EGFR 19阳性者（x2=5.779,P=0.016）.结论 EGFR不同基因突变类型在HRCT表现和病理亚型上差异无统计学意义,双肺转移型肺腺癌多有EGFR 21基因突变.

Objective To investigate the relationship of the preoperative HRCT,postoperative pathological subtype and EGFR gene mutation types in the patients of small peripheral lung adenocacinoma confirmed by operation.Methods Between December 2011 and November 2014,Ninety-four invasive adenocarcinoma patient were selected from 156 patients with pulmonary nodule underwent operation in Beijing Chaoyang hospital.Among them,there were male 37 cases,female 57 cases,age range from 32 to 76,mean age 52.6.All patients underwent complete anatomical lobectomy or wedge resection or segmentectomy,with systematic mediastinal lymph node dissection.The detection indexes included：preoperative HRCT,postoperative pathological subtypes,lymph node; EGFR,Kras,ALK,FGF9 gene expression and so on.Results Postoperative pathologic acinar predominant accounted for 33.0% （31/94）,papillary predominant type accounted for 25.5% （24/94）,Lepidic predominant adenocarcinoma accounted for 19.1% （18/94）,13.8% （13/94） micro papillary predominant,8.5% （8/94） solid predominant.7 patients with lymph node positive included 5 cases of stations 11-12,1 case of station 4 and 1 case of station 7.36 cases was detected EGFR mutation after operation （38.9%,36/94）,mainly 19＋ and 21 ＋.Compared with the preoperative HRCT findings,there was no significant difference in EGFR mutation group and non mutation group（x2 =1.411,P =0.703）.For different types of mutations in EGFR gene,there was no statistical difference （P 〉 0.05）.But the rate of EGFR 21 positive in progression patients was significantly higher than that of EGFR 19 positive patients （x2 =5.779,P =0.016）.Conclusion There were no significant different between the HRCT manifestations and pathological subtypes in the rate of EGFR gene mutation.EGFR 21 gene mutation was found in double lung metastasis commonly.