孤立性浸润性肺腺癌CT征象与EGFR基因突变的相关性分析

Relationship between MSCT signs of solitary invasive lung adenocarcinoma nodules and EGFR gene mutation

目的 探讨孤立性浸润性肺腺癌CT影像学表现与表皮生长因子受体(EGFR)基因突变的相关性。方法 选取75例经手术病理证实为浸润性肺腺癌的患者,且均进行了EGFR基因测定。将75例分为两组:基因突变型组(52例)和基因野生型组(23例)。分析每例患者的临床资料及CT影像学征象,包括性别、年龄、临床症状、抽烟史,结节大小、结节边界、结节的形态及内部特征,如空泡征、分叶征、空气支气管征、血管聚集征、胸膜牵拉、凹陷征、 G/T值(磨玻璃成分与GGN的最大径之比)等,观察比较上述征象在两组病例中是否具有差异性。计数资料采用卡方检验,定量资料采用两独立样本t检验,并将单因素分析中有价值的变量纳入多因素回归分析,再通过非条件二分类logistic回归分析预测孤立性浸润性肺腺癌发生基因突变的独立危险因素,纳入ROC曲线,将有统计学意义的危险因素作为预测指标,从而进一步对此类浸润性肺腺癌结节是否存在基因突变进行提示预测。结果 两组患者的年龄,吸烟史,临床症状、结节边界,分叶征,血管集束征,支气管充气征等差异无统计学意义(P>0.05)。将结节最大径,胸膜凹陷,G/T比单因素分析具有意义的变量,纳入多因素回归分析,通过非条件二分类logistic回归分析,结果表明:结节的最大径、胸膜凹陷征可以做为预测浸润性腺癌发生基因突变的独立危险因素,差异有统计学意义(P<0.05)。应用ROC曲线将结节最大径为预测指标,进一步对浸润性腺癌进行预测,结果表明以结节最大径为1.55 cm为截断值,对浸润性腺癌发生基因突变具有很好的预测提示意义。结论 孤立性浸润性肺腺癌结节EGFR表达与影像学表现之间存在一定的相关性,通过影像学的分析,可有助于预测EGFR突变情况。

Objective To investigate the correlation between CT imaging manifestations of nodules in isolated invasive lung adenocarcinoma and mutations in epidermal growth factor receptor(EGFR)genes.Methods The imaging data and pathological results of 75 patients with invasive lung adenocarcinoma confirmed by surgical pathology in our hospital were retrospectively analyzed,and all cases were assayed by EGFR gene.All cases were divided into two groups:the genotype group(52 cases)and the wild type group(23 cases).The clinical data of each case and MSCT manifestations,including gender,age,smoking history,clinical symptoms,nodule boundary,nodule size,lobulated sign,cavitation character,air bronchogram,blood vessels,(pleural retraction,depression),G/T value(grinding glass composition and ratio of the maximum diameter of GGN),etc.were analyzed.The differences of the signs in the two groups were evaluated.Quantitative data were analyzed by using two independent sample t-test,count data by chi-square test,and single factor analysis of meaningful variables were assessed with multiple factors regression analysis,and the unconditioned binary classification,then logistic regression to predict the isolation infiltrating adenocarcinoma independent risk factors for the development of gene mutation was taken.The ROC curve was used to evaluate the significant risk factors as predictors,gene mutation to make predictions related with the existence of infiltrating adenocarcinoma.Results There was no statistical difference in the age,smoking history,clinical symptoms,nodule boundary,lobulated sign,vascular cluster,and bronchogram.The variables of significance for the maximum diameter of nodules,air bronchial signs,and G/T ratio univariate analysis were incorporated into the multifactor regression analysis,and the results showed that the maximum diameter of the nodule,pleural traction,and depression signs could be used as independent risk factors for predicting the development of genetic mutations in invasive adenocarcinoma(P<0.05).The ROC curve was used to predict the invasive adenocarcinoma with the diameter of the nodule as the prediction index. The results showed that the cut ff value of the nodule with the maximum diameter of 1.55 cm had a good prediction effect on the gene mutation of the invasive adenocarcinoma.Conclusion There is a certain relationship between the expression of EGFR in the nodules of solitary invasive lung adenocarcinoma and the imaging findings.