非小细胞肺癌患者EGFR基因突变与CT征象及临床特征的关系

Relationship between EGFR mutation and CT features and clinical features in patients with non small cell lung cancer

目的探讨非小细胞肺癌(NSCLCs)患者表皮生长因子受体(EGFR)基因突变与CT征像及临床特征的关系。方法回顾性分析2014年9月—2016年7月我院收治的187例接受EGFR突变基因检测的NSCLCs中腺癌患者的临床资料,其中EGFR有效突变67例(有效突变组)、未有效突变120例(非有效突变组)。2组患者临床资料肺部CT影像学资料完整,分别采用单因素和多因素Logistic回归分析NSCLCs患者发生EGFR的影响因素。结果与非有效突变组比较,EGFR有效突变组中女性患病比例较高,吸烟指数较低,患者肺组织病灶CT表现为边缘较清晰,呈现分叶、毛刺,病灶多含有磨玻璃影(GGO)成分,伴有气道支气管征和胸膜凹陷征的表现,并易伴发癌性淋巴管炎和肺转移(均P<0.05)。2组肺组织出现坏死、空洞、钙化、晕征和空泡征的比例差异无统计学意义(P>0.05)。Logistic回归分析显示,女性、含有GGO成分、毛刺、有气道受累、癌性淋巴管炎是NSCLCs患者发生EGFR有效突变的危险因素。结论 EGFR有效突变好发于女性,其CT的可靠预测征象为含有GGO成分、毛刺、含气支气管征、癌性淋巴管炎。对临床中不易获取病理的危重患者,进行EGFR有效突变的CT影像学评估及预后预测具有一定指导意义。

Objective To investigate the relationship between epidermal growth factor receptor （EGFR） gene mutation and computed tomography （CT） features and clinical features in non-small cell lung cancer （NSCLCs） patients. Methods The clinical data of 187 patients with NSCLCs admitted in our hospital from September 2014 to July 2016 were retrospectively analyzed. All the patients accepted the EGFR mutated gene detection, and they were divided into effective mutation group （n=67） and non-effective mutation group （n=120）. The clinical data and lung CT imaging data were complete in the two groups. The univariate and multivariate Logistic regression analysis were used to analyze the differences of imaging and clinical features between the two groups. Results Comparing with the non-mutation group, there were higher proportion of women and lower smoking index in the EGFR effective mutation group. Lesions in the lung tissue showed a clear edge, leaf and burr, and containing ground-glass opacity （GGO） component, usually accompanied by airway bronchogram and pleural indentation, and associated with cancer lymphatic inflammation and lung metastasis in mutation group （all P 〈 0.05）. There were no significant differences in the proportion of necrosis, cavitation, calcification, halo sign and vacuole sign between the two groups （P 〉 0.05）. Logistic regression analysis showed that female, GGO containing composition, burr, air bronchogram, carcinomatous lymphangitis and lesion density showed obvious airway involvement were the predictive risk factors in patients with EGFR effective mutation. Conclusion The EGFR mutation occurs more oftern in female. The reliable predictive signs of CT include GGO composition, burr, airway bronchogram and carcinoid lymphangitis. In critical patients who are not easy to obtain clinical pathology, it has a guiding significance to radiographic assessment for EGFR effective mutation.