18F-FDG摄取与甲状腺转录因子-1表达预测肺腺癌患者表皮生长因子受体突变的价值

Values of 18F-FDG uptake and thyroid transcription factor-1 expression to predict the mutations of epidermal growth factor receptor in lung adenocarcinoma

目的探讨肺腺癌患者18F-脱氧葡萄糖（FDG）摄取与甲状腺转录因子-1（TTF-1）表达在预测表皮生长因子受体（EGFR）突变中的价值。方法回顾性分析2012年5月至2016年5月问137例（男89例，女48例，年龄33～84岁）经病理证实的肺腺癌患者的临床资料，所有患者治疗前均行18F-FDGPET／CT检查及18F-1、EGFR突变检测。采用疋。检验比较不同组别间EGFR突变的差异：采用两样本t检验比较EGFR突变型与野生型、18F-1阳性表达组及阴性表达组间最大标准摄取值（SUV…）的差异；采用logisitic回归进行多因素分析；采用受试者工作特征（ROC）曲线分析各指标的预测价值。结果EGFR突变53例，其中18号外显子突变2例，19号外显子突变19例，20号外显子突变3例，2l号外显子突变29例。EGFR突变在女性（疋。=7．465，P=0．006）、不吸烟（X^27．193，P=0．007）、18F-1表达阳性（X^2=9．104，P〈0．05）患者中较高；EGFR突变型患者SUVmax明显低于EGFR野生型患者（8．76±4．59和11．20±5．09；t=2．832，P=0．005）；多因素分析显示，18F-1阳性、SUVmax〈8．65是EGFR突变的独立影响因子（P=0．018，P=0．032）。SUVmax联合TTF-1表达预测EGFR突变的ROC曲线下面积最大（其值为0．697）。结论对肺腺癌患者进行18F-FDGPET／CT及，18F-1联合检查，可在一定程度上预on．0EGFR的突变状况，能够为临床治疗决策提供依据。

Objective To validate the value of lSF-fluorodeoxyglucose （FDG） uptake on PET/CT and thyroid transcription factor-1 （TI＇F-1） expression to predict the epidermal growth factor receptor （EGFR） mutations in lung adenocarcinoma. Methods From May 2012 to May 2016, a total of 137 lung adenocarci- noma patients （89 males, 48 females, age range 33-84 years） pathologically proved were reviewed retro- spectively. EGFR mutation testing, TFF-1 expression and PET/CT scan were performed for all patients. X2 test was used to assess the differences of EGFR mutation in different groups. Two-sample t test was used to compare the differences of maximum standardized uptake value （ SUVmax ） between EGFR mutation type and EGFR wild type, TTF-1 positive and negative expression. Multivariate logistic regression analysis was used to test the univariate models that yielded the best predictors of EGFR mutation receiver operating characteris- tic （ROC） curve analysis was performed to quantify the predictive value of those factors. Results EGFR mutation was identified in 53 patients, including 2 cases in exon 18, 19 cases in exon 19, 3 cases in exon 20 and 29 cases in exon 21. The high risk factors of EGFR mutation were female （X^2= 7.465, P=0.006） , non-smoking （X2 = 7.193, P = 0.007） and positive expression of TTF-1 （X^2 = 9.104, P〈0.05）. The SUVmax of EGFR mutation type was significantly lower than that of EGFR wild type （8.76±4.59 and 11.20±5.09; t = 2. 832, P = 0.005 ）. Multivariate analysis showed that the lower SUVm,x （SUVmax 〈 8.65 ） and positive expres- sion of TFF-1 were the independent risk factors for EGFR mutation （P= 0.032, P= 0.018）. The combined use of SUVm,X and TFF- 1 yielded a higher area under the ROC curve （ area under curve = 0.697） , suggesting a good diserimination. Conclusion The combined evaluation of ISF-FDG uptake and expression of TFF-1 may be helpful in predicting EGFR mutation status in patients with lung adenocareinoma, especially when the genetic testing is not available, and can provide meaningful clues for clinical treatment.