^18F-FDG PET/CT对肺腺癌患者EGFR突变的预测价值

Predictive value of^18F-FDG PET/CT for EGFR mutations in patients with lung adenocarcinoma

目的研究^18F-脱氧葡萄糖(FDG)PET/CT参数预测肺腺癌患者表皮生长因子受体(EGFR)突变的价值。方法回顾性分析2013年1月至2017年12月间在山西省肿瘤医院进行PET/CT显像和EGFR突变检测的146例经病理证实为肺腺癌的患者[男83例,女63例,年龄(60.2±10.3)岁]资料。采用两独立样本t检验、χ^2检验或Fisher确切概率法比较EGFR突变组和野生组患者的临床资料[年龄、性别、吸烟情况、肿瘤直径、淋巴结转移、远处转移、分期、甲状腺转录因子1(TTF-1)、NapsinA、细胞角蛋白(CK)-7、细胞增殖核抗原Ki-67评分]及PET/CT相关参数[原发肿瘤最大标准摄取值(SUVmax)、淋巴结SUVmax、远处转移SUVmax];采用二元logistic回归分析预测EGFR突变的独立因素;应用受试者工作特征(ROC)曲线评估原发肿瘤SUVmax及其联合性别、吸烟情况、肿瘤直径预测EGFR突变的效能。结果EGFR突变型患者46.58%(68/146),野生型患者53.42%(78/146)。2组患者在性别、吸烟情况、淋巴结转移、肿瘤直径、原发肿瘤SUVmax、淋巴结SUVmax、TTF-1、NapsinA、细胞增殖核抗原Ki-67评分的差异有统计学意义(t=-3.023^-2.032,χ^2=4.725~33.749,均P<0.05)。Logistic回归分析显示,女性[比值比(OR)=3.236,95%CI:1.213~8.779;P=0.029]、不吸烟者(OR=4.947,95%CI:1.796~13.621;P=0.019)、原发肿瘤SUVmax<9.1(OR=2.960,95%CI:1.227~7.141;P=0.016)、肿瘤直径<3.5 cm(OR=2.750,95%CI:1.109~6.818;P=0.001)是肺腺癌患者EGFR突变的预测因子。原发肿瘤SUVmax的ROC曲线下面积(AUC)为0.64,特异性和灵敏度分别为43.6%(34/78)和27.9%(19/68);4种预测因子联合的AUC为0.83,特异性和灵敏度分别为71.8%(56/78)和83.8%(19/68)。结论原发肿瘤SUVmax可预测肺腺癌患者的EGFR突变,联合性别、吸烟情况、肿瘤直径时,其预测能力更强。

Objective To investigate the predictive value of^18F-fluorodeoxyglucose(FDG)PET/CT imaging for the epidermal growth factor receptor(EGFR)mutations in patients with lung adenocarcinoma.Methods From January 2013 to December 2017,a total of 146 patients(83 males,63 females,age:(60.2±10.3)years)who were confirmed as lung adenocarcinoma by pathology and were examined by^18F-FDG PET/CT imaging and EGFR mutation testing in Shanxi Cancer Hospital were retrospectively analyzed.The differences of clinical characteristics(age,gender,smoking,tumor diameter,loymph node metastasis,distant metastasis,stage,thyroid transcripition factor-1(TTF-1),NapsinA,cyiokeratin(CK)-7,Ki-67)and PET/CT parameters(maximun standardized uptake value(SUVmax)of the primary tumor(pSUVmax),SUVmax of lymph node(nSUVmax)and SUVmax of distant metastasis(mSUVmax))between patients of EGFR mutation and EGFR wild type were analyzed using independent-sample t test,χ^2 test and Fisher exact test.The predictors for EGFR mutation were analyzed by logistic regression analysis.The predictive value of pSUVmax and pSUVmax combined with gender,smoking and tumor diameter was determined by receiver operating characteristic(ROC)curve analysis.Results There were 46.58%(68/146)patients with EGFR mutations and 53.42%(78/146)patients with wild type.Gender,smoking,lymph node metastasis,tumor diameter,pSUVmax,nSUVmax,TTF-1,NapsinA and Ki-67 were significantly different between patients with EGFR mutations and those with wild type(t values:from-3.023 to-2.032,χ^2 values:4.725-33.749,all P<0.05).Female(odds ratio(OR)=3.236,95%CI:1.213-8.779;P=0.029),non-smoker(OR=4.947,95%CI:1.796-13.621;P=0.019),tumor diameter<3.5 cm(OR=2.750,95%CI:1.109-6.818;P=0.001)and pSUVmax<9.1(OR=2.960,95%CI:1.227-7.141;P=0.016)were predictors of EGFR mutations in lung adenocarcinoma.The area under the curve(AUC)of pSUVmax was 0.640 with the specificity of 43.6%(34/78)and the sensitivity of 27.9%(19/68),while the AUC of the four independent factors was 0.83 with the specificity of 71.8%(56/78)and the sensitivity of 83.8%(19/68).Conclusions pSUVmax is associated with mutant EGFR status.Moreover,the combination of pSUVmax,gender,smoking and tumor diameter can enhance the predictive value on EGFR mutation status in patients with lung adenocarcinoma.