周围型肺腺癌EGFR基因突变与其CT上磨玻璃成分含量、病理表现的相关性研究

发布时间：2018-02-02 08:23

  本文关键词： 肺腺癌 表皮生长因子受体 计算机体层成像 磨玻璃影 组织学分型　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨周围型肺腺癌表皮生长因子受体(EGFR)基因突变与其CT上磨玻璃影(GGO)成分含量、病理表现的相关性。材料与方法:回顾性分析245例经术后病理证实的周围型肺腺癌的影像及临床资料,男75例,女170例,年龄27-81岁,平均年龄60.3岁。运用扩增阻滞突变系统(ARMS)检测腺癌组织的EGFR基因突变情况,包括外显子18点突变、外显子19缺失突变、外显子20插入突变以及外显子21点突变;肿瘤的病理组织学分型依据2015年世界卫生组织(WHO)公布的肺腺癌新分类进行划分;利用西门子Somatom Definition Flash CT后处理工作站测量肿瘤GGO成分的体积比(即GGO成分占肿瘤总体积的百分比)并分为四型,分别为Ⅰ型(0GGO≤25%)、Ⅱ型(25%GGO≤50%)、Ⅲ型(50%GGO≤75%)及Ⅳ型(75%GGO≤100%);测量肿瘤最大横断面长径(D)并分为六组,分别为D≤1.0cm、1.0cmD≤1.5cm、1.5cmD≤2.0cm、2.0cmD≤2.5cm、2.5cmD≤3.0cm及D3.0cm。患者EGFR基因突变状态在性别、吸烟情况、病理分型、肿瘤大小、CT上GGO含量分型中的差异采用卡方检验,P0.05具有统计学意义;EGFR基因突变状态与肿瘤CT上GGO体积比的趋势分析采用趋势卡方检验,P0.01具有统计学意义。结果:女性患者中EGFR基因突变率(81.2%)及外显子21突变率(50.6%)均高于男性患者(65.3%、36.0%),P0.05。非吸烟患者中EGFR基因突变率(81.0%)及外显子21突变率(51.5%)均高于吸烟患者(55.6%、22.2%),P0.05。EGFR基因突变状态在不同病理分型中的差异具有统计学意义,浸润性粘液腺癌EGFR基因突变率(0%)显著低于非浸润性粘液腺癌(79.2%),P0.05;以贴壁生长为主的腺癌外显子21突变率(65.8%)高于非贴壁生长为主的腺癌(37.3%),P0.05;以贴壁生长为主的腺癌外显子19突变率(13.2%)低于非贴壁生长为主的腺癌(29.0%),P0.05。EGFR基因突变状态在肿瘤D不同分组中的差异无统计学意义,P0.05。外显子21、19突变率在不同GGO含量分型中的差异均具有统计学意义,P0.05;Ⅳ型的外显子21突变率(57.7%)高于Ⅰ型(29.6%),P0.0083,其余各型间两两比较均无统计学差异;Ⅱ型的外显子19突变率(40.9%)高于Ⅳ型(15.3%),P0.0083,其余各型间两两比较均无统计学差异。外显子21、19突变率均与肿瘤CT上GGO体积比存在一定趋势关系,且具有统计学意义(P0.01)。结论:在含有GGO成分的周围型肺腺癌中,其性别、吸烟情况、病理类型及CT上GGO体积比对于预测EGFR基因突变类型有一定的价值。EGFR基因突变及外显子21突变常见于女性、非吸烟患者。浸润性粘液腺癌极少发生EGFR基因突变,外显子21突变常见于以贴壁生长为主的腺癌。随着肿瘤在CT上GGO成分含量的增加,外显子21突变的几率随之升高,而外显子19突变的几率随之降低。
[Abstract]:Objective: To investigate the peripheral lung adenocarcinoma epidermal growth factor receptor (EGFR) gene mutation and CT on the ground glass opacity (GGO) content, the correlation between the pathological manifestations. Materials and methods: a retrospective analysis of 245 cases of peripheral lung cancer confirmed by surgery and pathology imaging and clinical data of 75 cases of male., 170 cases were female, age 27-81 years old, the average age of 60.3 years. The use of amplification refractory mutation system (ARMS) detection of EGFR gene in adenocarcinoma of the mutations, including mutations of exon 18, exon 19 deletion mutations, exon 20 insertion mutation and exon 21 mutation; tumor the pathological type according to the 2015 WHO (WHO) announced a new classification of lung adenocarcinoma were divided by Somatom Definition Flash; SIEMENS CT postprocessing workstation GGO component measurement of tumor volume ratio (i.e. GGO components accounted for total tumor volume percentage) and divided into four types, respectively, i. Type (0GGO = 25%), type II (25%GGO = 50%), type III (50%GGO = 75%) and type IV (75%GGO = 100%); measurement of tumor maximum cross-sectional length diameter (D) were divided into six groups, respectively, D = 1.0cm, 1.0cmD = 1.5cm, 1.5cmD = 2.0cm, 2.0cmD = 2.5cm. 2.5cmD = EGFR and 3.0cm in patients with D3.0cm. mutation status in gender, smoking status, pathological type, tumor size, GGO content of CT on the difference in using the chi square test, P0.05 was statistically significant; analysis and tumor CT GGO volume ratio trend by trend test statistics with EGFR gene mutation the significance of P0.01. Results: the mutation rate of EGFR gene in female patients (81.2%) and exon 21 mutation rate (50.6%) was higher than that of male patients (65.3%, 36%), non P0.05. gene EGFR mutation rate in patients with smoking (81%) and exon 21 mutation rate (51.5%) was higher than that in patients with smoking (55.6%. 22.2%), P0.05.EGFR gene mutation status 鍦ㄤ笉鍚岀梾鐞嗗垎鍨嬩腑鐨勫樊寮傚叿鏈夌粺璁″�︽剰涔�,娴告鼎鎬х矘娑茶吅鐧孍GFR鍩哄洜绐佸彉鐜，

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