晚期肺腺癌CT特征与EGFR基因突变的关系

目的探讨晚期肺腺癌的CT特征与表皮生长因子受体(EGFR)基因突变的相关性。方法回顾性分析137例晚期肺腺癌患者的CT影像学特征和临床资料,所有患者的病理组织都行EGFR基因检测,根据EGFR基因突变情况分成两组:EGFR突变组和非突变组,分别采用单因素和多因素Logistic回归分析晚期肺腺癌患者发生EGFR突变的影响因素。结果137例患者中,71例(51.82%)表皮生长因子受体突变阳性。与非突变组比较,EGFR突变组中女性患者比例较高(P<0.05)。两组在肺肿瘤大小、坏死、空洞、支气管充气征及远处转移等差异无统计学意义(P>0.05)。Logistic回归分析显示,女性、无肺气肿、原发肿瘤的分叶程度、淋巴结的大小和状态是晚期肺腺癌患者发生EGFR突变的危险因素。结论EGFR有效突变好发于女性,其CT的可靠预测因素为无肺气肿、原发肿瘤的分叶程度、淋巴结的大小和状态。在临床工作中,对晚期危重患者,当不能获取病理组织时,可以通过CT特征结合临床资料来预测晚期肺腺癌是否存在EGFR突变。

Relationship between EGFR mutation and CT features in advanced pulmonary adenocarcinoma

Objective To investigate the association between CT characteristics of advanced pulmonary adenocarcinoma and epidermal growth factor receptor(EGFR)gene mutation.Methods The clinical presentations and CT characteristics of 137 advanced pulmonary adenocarcinoma were retrospectively analyzed.All the patients accepted the EGFR mutated gene detection,and they were divided into the mutation group(n=71)and the no mutation group(n=66).The univariate and multivariate logistic regression analysis were used to analyze the differences of imaging and clinical features between the two groups.Results Of the 137 patients,71(51.82%)had positive EGFR mutations.Compared with the non-mutation group,there were higher proportion of women in the EGFR mutation group(P<0.05).There was no significant differences in the proportion of size,necrosis,cavitates,air bronchogram,and distant metastasis between the two groups(P>0.05).The logistic analysis regression indicated that female,no emphysema,degree of primary tumor lobulation,size and status of lymph nodes were the risk factors of patients with EGFR mutation.Conclusion The EGFR mutation occurs more often in female.The reliable predictive signs of CT include emphysema,degree of primary tumor lobulation,and lymph node size and status.For critical patients who are not easy to obtain clinical pathology,CT characteristics and clinical presentation are useful for predicted EGFR mutations in advanced pulmonary adenocarcinoma.