SMARCA4缺失型非小细胞肺癌CT影像、病理及临床特征分析

Analysis of CT imaging,pathology and clinical features of SMARCA4-deficient non-small cell lung cancer

目的探讨SMARCA4/BRG1缺失型非小细胞肺癌(SMARCA4-dNSCLC)影像、病理及临床特征。方法回顾性分析2020年9月至2023年9月福建医科大学附属泉州市第一医院43例SMARCA4-dNSCLC患者的临床、病理及影像学资料,包括CT表现、组织学特征及免疫组化表现、治疗策略及随访资料。结果43例患者中T1期5例、T2期12例、T3期11例、T4期15例,22例有远处转移;男41例,女2例;中位年龄61岁;有吸烟史32例。肿瘤最大径中位数为52 mm。存在毛刺征28例,分叶征41例,空泡或空洞9例,坏死35例,血管集束征34例,胸膜凹陷征34例,胸腔积液8例,胸内淋巴结肿大30例,肺内转移灶≥10个6例,合并肺气肿、肺大泡35例。病理组织学表现为43例肿瘤组织排列均成实性片状、岛状或结节状,其中32例伴有大片坏死,多数为异形上皮样细胞形态,细胞黏附性差,核大深染。TTF-1阳性11例,CK7阳性30例,HepPar-1阳性28例。PD-L1≥1%有19例,10例患者出现TP53突变。患者中行手术治疗14例,化疗联合免疫治疗15例,化疗7例,放疗2例。有随访资料35例,5例死于肿瘤引起的并发症,其余30例目前带病存活。结论SMARCA4-dNSCLC的临床、病理及CT表现均存在一定特征,有助于患者的个体化诊断及治疗。

Objective To investigate the imaging,pathological and clinical features of SMARCA4/BRG1-deficient non-small cell lung cancer(SMARCA4-dNSCLC).Methods Retrospective analysis of clinical,pathological,and imaging data of 43 SMARCA4-dNSCLC patients at Quanzhou First Hospital Affiliated to Fujian Medical University from September 2020 to September 2023,including CT findings,histological features and immunohistochemical findings,treatment strategies and follow-up data.Results Among 43 patients,there were 5 patients in T1 phase,12 patients in T2 phase,11 patients in T3 phase,15 patients in T4 phase,and 22 patients had distant metastasis,and there were 41 males and 2 females.The median age was 61 years old.There were 32 patients with smoking history.The median maximum diameter of tumor was 52 mm.There were 28 patients with burr sign,41 patients with lobulation sign,9 patients with vacuole or cavity,35 patients with necrosis,34 patients with vascular convergence sign,34 patients with pleural indentation sign,8 patients with pleural effusion,30 patients with intrathoracic lymphadenopathy,6 patients with pulmonary metastases≥10,and 35 patients with complications of emphysema and bullae.Histopathological findings showed that tumor tissues of 43 patients were all arranged in solid sheets,islands or nodules,of which 32 patients were accompanied by large necrosis,most of which were atypical epithelioid cells with poor cell adhesion and large and dark nuclei.TTF-1 was positive in 11 patients,CK7 in 30 patients and HepPar-1 in 28 patients.There were 19 patients with PD-L1≥1%,and 10 patients had TP53 mutation.Fourteen patients underwent surgery,15 patients underwent chemotherapy combined with immunotherapy,7 patients underwent chemotherapy and 2 patients underwent radiotherapy.There were 35 patients with follow-up data,5 patients died of complications caused by tumors,and the remaining 30 patients were currently alive with diseases.Conclusion The clinical,pathological and CT features of SMARCA4-dNSCLC have certain characteristics,which are helpful for individuali zed diagnosis and treatment of patients.