肺腺癌中EGFR基因突变的肺部基础病变CT及临床特点

The Characteristics of CT and Clinic with Epidermal Growth Factor Receptor Mutations in Lung Adenocarcinoma

目的探讨肺腺癌中EGFR基因有效突变的肺部基础病变CT及临床的特点。方法搜集自2014年9月至2016年7月经过EGFR基因检测的具有完整临床及影像学资料的187例肺腺癌的病例,有效突变组67例,非有效突变组(对照组)120例,记录肺部基础病变CT影像特征及临床实验室血肿瘤标记物等情况,定量数据资料分析使用独立样本t检验或秩和检验;定性数据资料分析使用卡方检验或者Fisher确切概率法;对单因素分析差别有统计学意义的变量进行多因素Logistic回归分析,系统评价EGFR基因突变与肺部基础病变及临床实验室检查结果的关系。结果临床及实验室方面,EGFR有效突变组与对照组相比,女性好发(56.7%vs 35.0%,P=0.004)、低吸烟指数(平均秩次80.53 vs 101.52,P=0.007)、血肿瘤标记物CEA多发阳性(62.7%vs 37.5%,P=0.001)、C19少见阳性(14.9%vs 32.5%,P=0.009)。多元分析得出,EGFR基因有效突变多发生于女性(OR值2.328,95%CI1.169~4.636),血肿瘤标记物CEA多阳性(OR值4.337,95%CI 2.081~9.041),血肿瘤标记物C19少见阳性(OR值0.274,95%CI 0.114~0.659)。肺部基础病变CT特点,EGFR有效突变多伴轻度间质改变的磨玻璃密度影(40.3%vs 19.2%,OR值3.266,95%CI 1.497~7.125,P=0.002);少见"蜂窝征"(3%vs 18.3%,OR值0.182,95%CI 0.038~0.880,P=0.003)。结论 EGFR有效突变多发生于女性、低吸烟指数;血肿瘤标记物CEA阳性多发,C19阳性少见。EGFR有效突变多伴轻度间质改变中的磨玻璃密度影。"蜂窝征"为EGFR有效突变的保护因素,即CT影像发现"蜂窝征",EGFR有效突变几率小。

Objective To investigate the CT and clinical characteristics with EGFR mutations in lung adenocarcinoma.Methods In this retrospective study we enrolled subjects from September 2014 to July 2016. The EGFR expression in 187 cases with lung adenocarcinoma was detected by immunohistochemical method,including 67 cases with EGFR mutations and120 cases with absence of EGFR mutations. CT features of underlying lung disease and clinical data including positive rate of Serum tumor markers（ CEA6、C-19） were recorded. Quantitative data analysis used independent sample t-test or rank and inspection. Qualitative data analysis used the chi-square test or Fisher＇s exact probability method. A multiple logistic regression model was applied to underlying lung disease CT features and clinical features. Results Clinical and Laboratory： EGFR mutations occurred more frequently in female（ 56. 7% vs 35. 0%,P = 0. 004）,lower Smoking index（ Mean Rank80. 53 vs 101. 52,P = 0. 007）,higher positive rate of CEA（ 62. 7% vs 37. 5%,P = 0. 001）,lower positive rate of C-19（ 14. 9% vs 32. 5%,P = 0. 009）.The results of logistic regression analysis showed sex（ OR = 2. 328,95% CI = 1. 169-4. 636）,the positive rate of CEA（ OR = 4. 337,95% CI = 2. 081-9. 041） and the positive rate of C-19（ OR = 0. 274,95%CI = 0. 114-0. 659） to be independent predictors of EGFR mutations. The results of logistic regression analysis showed mild interstitial abnormalities（ ground-glass opacity）（ 40. 3% vs 19. 2%,OR = 3. 266,95% CI = 1. 497-7. 125,P =0. 002） and absence of honeycombing sign（ 3% vs 18. 3%,OR = 0. 182,95% CI = 0. 038-0. 880,P = 0. 003） to be independent predictors of EGFR mutations. Conclusion EGFR mutations occurred more frequently in female,lower Smoking index,high positive rate of CEA and low positive rate of C19 of Serum tumor markers in Adenocarcinomas. EGFR mutations mostly appeared as mild interstitial abnormalities（ ground-glass opacity） and absence of honeycombing sign.