表现为磨玻璃结节的肺腺癌表皮生长因子受体突变状态与^(18)F-脱氧葡萄糖摄取值的关系

Correlation analysis between the maximum standard uptake value based on 18F-fluorodeoxyglucose PET-CT and the epidermal growth factor receptor mutation status of lung adenocarcinoma appearing as ground glass nodules

目的探讨基于18F-脱氧葡萄糖(FDG)PET-CT的最大标准化摄取值(SUVmax)与表现为磨玻璃结节(GGN)的肺腺癌表皮生长因子受体(EGFR)突变状态的关系。方法回顾性分析2011年10月至2020年12月苏州大学附属第三医院肺腺癌的患者103例。所有患者均接受18F-FDG PET-CT和高分辨CT检查,并于1个月内接受手术切除及EGFR检测,依据有无EGFR突变分为EGFR突变组和EGFR野生组。在CT图像上分析患者的GGN数量、类型、位置、形状、分叶征、毛刺征、异常支气管征、空泡征、胸膜凹陷征、结节直径(DGGN)、实性成分直径(Dsolid)、结节磨玻璃成分CT均值(CTGGO),在PET-CT融合图像上测量结节的最大标准化摄取值(SUVmax)。采用t检验、Mann-WhitneyU检验或χ^(2)检验比较2组患者的临床、病理、CT表现及SUVmax值的差异。使用分层二元logistic回归模型评估不同亚组SUVmax和EGFR突变状态的关系,应用广义相加模型和平滑曲线拟合解决非线性问题,应用分段二元逻辑回归模型解释非线性。结果 103例患者共106个GGN,EGFR突变组75例(78个结节)和EGFR野生组28例(28个结节)。EGFR突变组毛刺征、胸膜凹陷征及浸润性腺癌的比例显著高于EGFR野生组(P<0.05),其余指标组间差异均无统计学意义(P>0.05)。调整年龄和空腹血糖后,性别和结节数显著影响了SUVmax和EGFR突变的关系(P<0.05),即存在交互作用。调整混杂因素后,SUVmax与女性EGFR突变状态之间呈现非线性关系(自由度为1.817,P=0.026),当SUVmax<2.4时,随SUVmax升高,EGFR突变风险显著增加(OR=43.621,95%CI 4.686~406.042,P<0.001);当SUVmax>2.4时,EGFR突变风险增加不显著(P=0.392)。结论表现为GGN的肺腺癌具有较高的EGFR突变风险;女性患者EGFR突变风险随着SUVmax的升高而增大,但存在饱和效应。

Objective To explore the relationship between the maximum standard uptake value(SUVmax)based on 18F-fluorodeoxyglucose(FDG)PET-CT and the epidermal growth factor receptor(EGFR)mutation status of lung adenocarcinoma appearing as ground glass nodules(GGN).Methods A total of 103 patients with lung adenocarcinoma from October 2011 to December 2020 in the Third Affiliated Hospital of Soochow University were retrospectively enrolled.All patients underwent 18F-FDG PET-CT and high-resolution CT,and underwent surgical resection and EGFR detecting within one month.The patients were divided into EGFR mutation group and wild group according to the EGFR test results.The GGN number,type,location,shape,lobulation sign,spicule sign,abnormal bronchial sign,vacuole sign,pleural indentation,diameter of GGNs(DGGN),diameter of solid component(Dsolid)and nodule ground-glass opacity component CT mean(CTGGO)were analyzed on CT images.The maximum standard uptake value(SUVmax)of nodules was measured on PET-CT images.The t test,Mann-Whitney U test orχ^(2) test were used to compare the differences of clinical data,pathological data,CT imaging parameters and SUVmax between the two groups.Hierarchical binary logistic regression model was used to assess whether there was any association between SUVmax and EGFR mutation status in different subgroups.Generalized additive model and smooth curve fitting were applied to solve nonlinear problems,and piecewise binary logistic regression model was used to explain nonlinearity.Results A total of 103 patients with 106 nodules were finally included.There were 75 patients(78 nodules)in the EGFR mutation group and 28 patients(28 nodules)in the EGFR wild group.Adenocarcinomas with EGFR mutation showed significantly higher spiculated edge,pleural depression sign and invasive adenocarcinoma proportions than those in EGFR wild group(P<0.05).There were no significant differences in other indicators between groups(P>0.05).After adjusting for age and fasting blood glucose,gender and the number of GGNs significantly affected the relationship between SUVmax and EGFR mutation(P<0.05),which suggested that there was an interaction.After adjusting for confounding factors,there was a non-linear relationship between SUVmax and EGFR mutation status in female subgroup(degree of freedom was 1.817,P=0.026).When SUVmax<2.4,the risk of EGFR mutation increased significantly with the increase of SUVmax(OR=43.621,95%CI 4.686-406.042),P<0.001].When SUVmax>2.4,the risk of EGFR mutation increased insignificantly(P=0.392).Conclusions Lung adenocarcinoma appearing as GGN has a higher risk of EGFR mutation.The risk of EGFR mutation in female patients increases with increasing SUVmax,but there is saturation effect.