危险因素联合检测对非小细胞肺癌EGFR突变状态的预测价值

The application value of risk factors combined detection in predicting the EGFR mutation in patients with non-small cell lung cancer

目的探讨基于危险因素联合检测预测非小细胞肺癌表皮生长因子受体(epidermal growth factor receptor,EGFR)突变状态的初步研究。方法选取2016年9月至2019年12月收治的晚期非小细胞肺癌患者102例,根据EGFR突变状态分为野生型组(n=71)和突变型组(n=31)。收集2组一般临床资料,采用Logistic回归构建非小细胞肺癌患者EGFR突变状态的联合检测因子模型,并绘制受试者工作特征曲线(ROC)。结果突变型组女性、无吸烟史、周围型肺癌、有原发灶毛刺、有肺内转移、有骨转移、有胸膜凹陷征、血清CEA≥8.05μg/L、CYFRA21-1<2.72μg/L、SUVmax≥6.005占比高于野生型组(P<0.05);经Logistic回归分析发现,部位(OR=1.322,95%CI=1.220~11.531)、胸膜凹陷征(OR=2.162,95%CI=1.906~39.608)、CYFRA21-1(OR=0.891,95%CI=1.015~5.854)及SUVmax(OR=1.062,95%CI=1.006~8.318)是影响非小细胞肺癌患者EGFR突变状态的独立危险因素;得出联合检测因子模型表达式为:Logit(P)=-4.551+1.322X1+2.162X2+0.891X3+1.062X4;联合检测因子模型最佳临界值为0.422,灵敏度为81.25%,特异度为92.86%,曲线下面积为0.847(0.689~0.999)。结论基于危险因素联合检测能较好的预测非小细胞肺癌患者EGFR突变状态。

Objective To investigate the application value of risk factors combined detection in predicting the EGFR mutation in patients with non-small cell lung cancer(NSCLC)Methods A total of 102 patients with advanced NSCLC who were treated in our hospital from September 2016 to December 2019 were enrolled in the study,who were divided into wild type group(n=71)and mutant group(n=31)according to mutation state of EGFR.The general data were collected,and Logistic regression was used to construct a combined detection factor model of neurological sequelae in patients with advanced NSCLC,moreover,the working characteristic curve(ROC)was drawn to evaluate the prediction efficiency of the model.Results In mutation group,the proportion of female,no smoking history,peripheral lung cancer,primary burr,intrapulmonary metastasis,bone metastasis,pleural depression,CEA≥8.05μg/L,CYFRA21-1<2.72μg/L,SUVmax≥6.005 were significantly higher than those in wild type group(P<0.05).Logistic regression analysis showed that tumor’s location,pleural indentation,CYFRA21-1 and SUVmax were independent risk factors for EGFR mutation in patients with NSCLC.The expression of combination detection factor model was:Logit(P)=-4.551+1.322X1+2.162X2+0.891X3+1.062X4.The best critical value of the combination detection factor model was 0.422,the sensitivity was 81.25%,the specificity was 92.86%,and the area under the curve was 0.847(0.689~0.999).Conclusion The combination dectection based on risk indexes can better predict the EGFR mutation in patients with NSCLC.