肺磨玻璃结节患者浸润性病变及间变性淋巴瘤激酶基因突变的影响因素分析

Influencing factors analysis of infiltrative lesion and anaplastic lymphoma kinase gene mutation in patients with lung ground glass nodule

目的分析肺磨玻璃结节(GGN)患者浸润性病变及间变性淋巴瘤激酶(ALK)基因突变的影响因素。方法选取我院肿瘤科2015年1月~2018年1月收治的80例疑似ALK基因突变肺GGN患者作为研究对象,其中浸润前病变30例,浸润性病变50例;ALK基因正常组患者36例,基因突变组患者44例,以病理结果作为金标准,分析浸润前病变、浸润性病变患者的病理状态以及ALK基因突变之间的差异,研究GGN侵袭性、ALK基因突变的影响因素。结果浸润前病变和浸润性病变的形态(毛刺征、分叶征、胸膜凹陷或牵拉征、支气管充气征或空泡征)、GGN大小、相对CT值、CT值、体积和质量比较,差异有统计学意义(P<0.05);Logistic回归分析显示,GGN质量(β=2.190,OR=8.935,95%CI:7.446~10.722)、体积(β=1.781,OR=5.936,95%CI:4.841~7.278)、CT值(β=1.709,OR=5.523,95%CI:4.694~6.499)、相对CT值(β=1.684,OR=5.387,95%CI:3.690~7.864)、大小(β=1.762,OR=5.824,95%CI:5.264~6.324)、毛刺征(β=1.594,OR=4.923,95%CI:4.184~5.793)、分叶征(β=1.665,OR=5.286,95%CI:4.153~6.727)、胸膜凹陷或牵拉征(β=1.606,OR=4.983,95%CI:4.413~5.627)、支气管充气征或空泡征(β=1.794,OR=6.013,95%CI:5.191~6.966)是浸润性病变的影响因素(P<0.05);ROC曲线显示,病灶质量≥0.276 g诊断GGN浸润性敏感度为80.0%(24/30),特异性为94.0%(47/50),ROC曲线下面积为0.872。基因突变组和基因正常组的GGN大小、体积、质量和侵袭性比较,差异有统计学意义(P<0.05);Logistic回归分析显示,质量(β=2.059,OR=7.838,95%CI:5.380~11.419)、体积(β=1.936,OR=6.931,95%CI:5.036~9.540)、大小(β=1.781,OR=5.936,95%CI:4.450~7.918)、侵袭性(β=1.635,OR=5.129,95%CI:4.031~6.528)是ALK基因突变的影响因素(P<0.05);GGN质量、体积和大小诊断ALK基因突变的最佳临界值分别为0.256 g、565.6 mm3、10.4 mm,ROC曲线下面积为0.803、0.781、0.755。结论ALK基因突变是肺GGN的侵袭的重要影响因素,高分辨率CT(HRCT)征象对于辅助预测GGN侵袭性、ALK基因突变具有重要价值。

Objective To analyze the influencing factors of infiltrative lesion and anaplastic lymphoma kinase(ALK)gene mutation in patients with lung ground glass nodule(GGN).Methods A total of 80 lung GGN patients suspected with ALK gene mutation admitted to oncology department of our hospital from January 2015 to January 2018 were selected as the research objects,including 30 cases with pre-infiltration lesions and 50 cases with infiltration lesions,36 patients in normal ALK gene group,44 patients in the gene mutation group.The pathological results were used as the gold standard to analyze the differences between the pathological status of patients with pre-infiltration lesions and infiltration lesions,as well as ALK gene mutations,and to study the influencing factors of GGN invasion and ALK gene mutations.Results There were statistically significant differences in morphology(hair prick sign,lobular sign,pleural indentation or stretch sign,bronchial inflation sign or vacuole sign),size,relative CT value,CT value,volume and mass between pre-infiltration lesions and infiltration lesions(P<0.05).Logistic regression analysis showed that GGN mass(β=2.190,OR=8.935,95%CI:7.446-10.722),volume(β=1.781,OR=5.936,95%CI:4.841-7.278),CT value(β=1.709,OR=5.523,95%CI:4.694-6.499),relative CT value(β=1.684,OR=5.387,95%CI:3.690-7.864),size(β=1.762,OR=5.824,95%CI:5.264-6.324),hair prick sign(β=1.594,OR=4.923,95%CI:4.184-5.793),lobular sign(β=1.665,OR=5.286,95%CI:4.153-6.727),pleural indentation or stretch sign(β=1.606,OR=4.983,95%CI:4.413-5.627),bronchial infla tion sign or vacuole sign(β=1.794,OR=6.013,95%CI:5.191-6.966)were influencing factors of infiltrative lesions(P<0.05).The ROC curve showed that the sensitivity of lesions≥0.276 g to diagnose GGN infiltration was 80.0%(24/30),the specificity was 94.0%(47/50),and the area under the ROC curve was 0.872.There were statistically significant differences in GGN size,volume,mass,and invasion between the gene mutation group and the normal gene group(P<0.05).Logistic regression analysis showed that mass(β=2.059,OR=7.838,95%CI:5.380-11.419),volume(β=1.936,OR=6.931,95%CI:5.036-9.540),size(β=1.781,OR=5.936,95%CI:4.450-7.918),and invasion(β=1.635,OR=5.129,95%CI:4.031-6.528)were the influencing factors of ALK gene mutation(P<0.05).The optimal cut-off values for ALK gene mutations diagnosed by GGN mass,volume and size were 0.256 g,565.6 mm3 and 10.4 mm,respectively,and the areas under the ROC curve were 0.803,0.781 and 0.755.Conclusion The mutation of ALK gene is an important factor affecting the invasion of GGN.High-resolution CT(HRCT)signs are of great value in the prediction of the invasion of GGN and the mutation of ALK gene.