天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (12): 1308-1312.doi: 10.11958/20170154

• 临床研究 • 上一篇    下一篇

非小细胞肺癌患者 EGFR 基因突变与 CT 征象及 临床特征的关系

张洪 1， 吕军 1， 徐美林 2， 高国政 2， 马延贺 1   

  1. 作者单位： 1 天津市胸科医院影像科 （邮编 300222）， 2 病理科 作者简介： 张洪 （1974）， 男， 副主任医师， 主要从事心胸部影像诊断研究
  • 收稿日期:2017-02-09 修回日期:2017-10-27 出版日期:2017-12-15 发布日期:2017-12-15
  • 通讯作者: 张洪 E-mail:yuxinli72@163.com

Relationship between EGFR mutation and CT features and clinical features in patients with non small cell lung cancer

ZHANG Hong1, LYU Jun1, XU Mei-lin2, GAO Guo-zheng2, MA Yan-he1   

  1. 1 Department of Radiology, 2 Department of Pathology, Tianjin Chest Hospital, Tianjin 300222, China
  • Received:2017-02-09 Revised:2017-10-27 Published:2017-12-15 Online:2017-12-15
  • Contact: zhang hong E-mail:yuxinli72@163.com

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摘要： 目的 探讨非小细胞肺癌（NSCLCs）患者表皮生长因子受体（EGFR）基因突变与 CT 征像及临床特征的关 系。方法 回顾性分析 2014 年 9 月—2016 年 7 月我院收治的 187 例接受 EGFR 突变基因检测的 NSCLCs 中腺癌 患者的临床资料， 其中 EGFR 有效突变 67 例 （有效突变组）、 未有效突变 120 例 （非有效突变组）。2 组患者临床资料 肺部 CT 影像学资料完整， 分别采用单因素和多因素 Logistic 回归分析 NSCLCs 患者发生 EGFR 的影响因素。结果 与非有效突变组比较， EGFR 有效突变组中女性患病比例较高， 吸烟指数较低， 患者肺组织病灶 CT 表现为边缘较清 晰， 呈现分叶、 毛刺， 病灶多含有磨玻璃影（GGO）成分， 伴有气道支气管征和胸膜凹陷征的表现， 并易伴发癌性淋巴 管炎和肺转移 （均 P＜0.05）。2 组肺组织出现坏死、 空洞、 钙化、 晕征和空泡征的比例差异无统计学意义 （P > 0.05）。 Logistic 回归分析显示， 女性、 含有 GGO 成分、 毛刺、 有气道受累、 癌性淋巴管炎是 NSCLCs 患者发生 EGFR 有效突变 的危险因素。结论 EGFR 有效突变好发于女性， 其 CT 的可靠预测征象为含有 GGO 成分、 毛刺、 含气支气管征、 癌 性淋巴管炎。对临床中不易获取病理的危重患者， 进行 EGFR 有效突变的 CT 影像学评估及预后预测具有一定指导 意义。

关键词: 癌, 非小细胞肺, 体层摄影术, X 线计算机, 突变, 基因, erbB-1, EGFR 基因

Abstract: Objective To investigate the relationship between epidermal growth factor receptor (EGFR) gene mutation and computed tomography (CT) features and clinical features in non-small cell lung cancer (NSCLCs) patients. Methods The clinical data of 187 patients with NSCLCs admitted in our hospital from September 2014 to July 2016 were retrospectively analyzed. All the patients accepted the EGFR mutated gene detection, and they were divided into effective mutation group (n=67) and non-effective mutation group (n=120). The clinical data and lung CT imaging data were complete in the two groups. The univariate and multivariate Logistic regression analysis were used to analyze the differences of imaging and clinical features between the two groups. Results Comparing with the non-mutation group, there were higher proportion of women and lower smoking index in the EGFR effective mutation group. Lesions in the lung tissue showed a clear edge, leaf and burr, and containing ground-glass opacity (GGO) component, usually accompanied by airway bronchogram and pleural indentation, and associated with cancer lymphatic inflammation and lung metastasis in mutation group (all P < 0.05). There were no significant differences in the proportion of necrosis, cavitation, calcification, halo sign and vacuole sign between the two groups (P > 0.05). Logistic regression analysis showed that female, GGO containing composition, burr, air bronchogram, carcinomatous lymphangitis and lesion density showed obvious airway involvement were the predictive risk factors in patients with EGFR effective mutation. Conclusion The EGFR mutation occurs more oftern in female. The reliable predictive signs of CT include GGO composition, burr, airway bronchogram and carcinoid lymphangitis. In critical patients who are not easy to obtain clinical pathology, it has a guiding significance to radiographic assessment for EGFR effective mutation.

Key words: carcinoma, non-small-cell lung, tomography, X-ray computed, mutation, genes, erbB-1, epidermal growth factor receptor genes