周围型浸润性肺腺癌EGFR基因突变与CT征象及病理的相关性

目的：探讨周围型浸润性肺腺癌表皮生长因子受体(EGFR)基因突变状态与 CT 征象及病理特征的相关性。方法收集193例经病理证实为周围型浸润性肺腺癌的手术标本,采用扩增阻滞突变系统对所有标本行 EGFR基因突变检测,结合胸部 CT征象及病理资料进行回顾性分析。结果193例中EGFR基因突变率为62.2%(120/193)。在CT征象方面：基因突变组与野生型组于横轴位上肿瘤最大直径(Dmax)分别为(2.52±1.01)cm和(3.11±1.34)cm,差异有统计学意义(P<0.05)。受试者工作特征曲线(ROC)提示Dmax=2.01 cm为判断 EGFR基因突变状态的最佳诊断阈值,敏感度与特异度分别为79%和64%。含磨玻璃密度影(GGO)的肿瘤突变率为78.0%,高于无 GGO 者(56.6%),P<0.05。肿瘤不伴有囊腔样改变者突变率为65.5%,高于伴有囊腔样改变者(40.0%),P<0.05。磨玻璃影/肿瘤直径比(G/T)、分叶征、毛刺征、胸膜凹陷征、血管集束征、空气支气管征、空泡征与EGFR基因突变率无显著相关性(P值均>0.05)。在病理特征方面：组织学亚型中以贴壁生长为主型突变率为77.5%,高于其他亚型(58.2%),P<0.05。以实体生长为主型突变率为26.3%,低于其他亚型(66.1%),P<0.05。无淋巴结转移者突变率为66.9%,高于淋巴结转移者(50.9%),P<0.05。结论在周围型浸润性肺腺癌中,部分CT征象及病理特征对于辅助预测 EGFR基因突变状态具有一定价值。

Correlation of CT features and pathological characteristics with EGFR gene mutations in invasive peripheral pulmonary adenocarcinoma

Objective To investigate the correlation of CT features and pathological characteristics with epidermal growth factor receptor(EGFR)gene mutations in invasive peripheral pulmonary adenocarcinoma.Methods The amplification refractory mutation system was used to determine EGFR mutations in 1 9 3 surgically resected invasive peripheral pulmonary adenocarcinomas.CT features and pathological characteristics were analyzed retrospectively.Results The total EGFR mutation rate was 62.2% (120/193).Among the features on CT,the maximum tumor diameter (Dmax)in axial plane CT images was significantly smaller in patients with EGFR mutations than that with wild-type EGFR patients (2.52 ± 1.01)cm vs (3.11 ± 1.34)cm,P<0.05].Receiver operating characteristic (ROC)results indicated that Dmax=2.01 cm was the diagnosis threshold in forecasting EGFR gene mutations,with the sensitivity and specificity of 79% and 64%,respectively.The frequency of EGFR mutations was significantly greater in tumors with ground-glass opacity(GGO)than that without GGO (78.0% vs 56.6%,P<0.05),and in tumors without cystic airspaces than that with cystic airspaces (65.5% vs 40.0%,P<0.05).No correlations were observed between EGFR mutations and other CT features,including GGO/tumor ratio(G/T),lobulation,spiculation,pleural retraction,vascular convergence,air bronchograms,and vacuole signs (P>0.05).Among pathological characteristics,compared with other subtypes,EGFR mutations occurred most frequently in lepidic predominant adeno-carcinomas (77.5% vs 58.2% in other subtypes,P<0.05),and the least frequently in solid predominant adenocarcinomas(26.3%vs 66.1% in other subtypes,P<0.05).The EGFR mutation rate was significantly higher in tumors without lymph node metastases than that with lymph node metastases (66.9%vs 50.9%,P<0.05).Conclusion The CT features and pathological characteristics may be useful indicators to predict EGFR mutation status in invasive peripheral pulmonary adenocarcinoma.