IA期周围型肺腺癌的CT特征与EGFR基因突变的相关性研究

目的探讨ⅠA期周围型肺腺癌的CT特征与表皮生长因子受体(EGFR)基因突变的相关性。方法收集2016年1月至2017年12月南京医科大学附属肿瘤医院58例ⅠA期肺癌患者资料,经手术证实为周围型肺腺癌,共68个病灶。回顾性分析其CT特征和临床资料,研究其与EGFR基因突变相关的危险因素。结果EGFR基因突变型占632％,依据高分辨率CT图像中结节的密度将病灶分为3组:肺内纯磨玻璃密度结节(PGGN)、部分实性结节(PST)、实性结节(ST)。3组图像与EGFR突变的相关性分析显示差异有统计学意义(P<005),PST组EGFR突变比例较高(32／44个,727％),ST组EGFR突变比例较低(2／7个,286％);但不能够预测EGFR突变亚型,L858R点突变和第19外显子缺失突变的各组比例相似(P>005)。EGFR突变阳性的病灶直径(186 cm±082 cm)较EGFR野生型(142 cm±061 cm)的要大、空气支气管征的出现率增多(581％ vs. 200％),差异均有统计学意义(均P<005);胸膜牵拉、深分叶及微血管征在EGFR突变的病灶中出现的比例较野生型EGFR高,但差异无统计学意义。结论IA期周围型肺腺癌患者中,PST、病灶的大小及含空气支气管征的结节与EGFR突变具有相关性,结合其他有意义的CT征象,可为EGFR突变情况提供重要信息,为临床精准医疗的开展提供决策支持。

Correlation between computed tomography images and EGFR gene mutations in patients with stage IA adenocarcinoma of the lung

Abstract] Objective To investigate the correlation between CT features and epidermal growth factor receptor (EGFR) gene mutations in peripheral non-small cell lung cancer (NSCLC) at IA stage. Methods CT features and clinical data of 68 patients with peripheral NSCLC confirmed by surgery at IA stage were retrospectively analyzed. Risk factors associated with EGFR gene mutation were determined by T test or chi-square test. Results EGFR mutations were found in 44 (64.7%) of 68 patients. The correlations between EGFR mutations and CT images in pure ground glass density nodules (PGGN), partial solid nodules (PST) and pulmonary solid nodules (ST) groups showed significant differences(P=0.047). And the proportion of EGFR mutations was highest(72.7%) in PST group，lowest（28.6%）in ST group. Whereas, the subtypes of EGFR mutations could not be predicted. The mutations proportion of L858R and exon 19 deletion in three groups were similar (P = 0.714). The diameter of lesions with positive EGFR mutation was larger(1.86±0.82cm) than that of wild type EGFR(1.42±0.61cm)and the occurrence rate of air bronchial sign was also increased(58.1% vs 20.0%), which were showed significantly differences (P=0.014, 0.002, respectively). The proportions of pleural traction, deep lobulation and microvascular were higher in the lesions with EGFR mutation than that of wild type EGFR, but there were no statistical differences. Conclusion In IA stage of lung adenocarcinomas, PST, nodules size and air bronchial sign were proved to have significant correlations with EGFR mutation. Combined with other meaningful CT signs, we could predict the pathological subtypes and EGFR mutations of lung adenocarcinomas, which would bring benefits to the clinical doctors.