探讨周围型肺腺癌患者CT影像及临床病理特征与表皮生长因子受体(EGFR)突变的相关性。

分析2017年9月至2018年4月于我院胸外科行手术治疗、术后病理确诊为周围型肺腺癌，并对术后大体病理标本进行EGFR基因检测的157例患者。由两名高年资影像科医生分别独立对术前一个月内胸部CT阅片分析，评估其影像特征，并结合临床、病理特征探讨EGFR突变的相关因素，利用Fisher精确检验、χ²检验、t检验、绘制ROC曲线进行分析，P<0.05为差异有统计学意义。

EGFR突变在MSCT影像表现中，有毛刺组突变率为65.1%(P＝0.012)，有胸膜凹陷组为64.6%(P＝0.044)，有磨玻璃影组为70.3%(P＝0.013)，具有统计学差异。女性患者中EGFR突变占68.0%(P＝0.002)，不吸烟患者中占69.2%(P＝0.000)，腺泡型、贴壁型、微乳头型、乳头型、实性型、浸润性粘液型，EGFR突变率分别为：68.5%、60.9%、50.0%、43.8%、22.2%、0.0%(P＝0.003)，差异有统计学意义。多变量回归分析显示：将所有显著特征统一预测EGFR突变时，ROC曲线的AUC为0.718。

原发性肺腺癌患者，EGFR突变易发生于女性不吸烟患者中，在腺泡型、贴壁型病理亚型易发生。影像学上伴有磨玻璃影，病灶边缘有毛刺、胸膜凹陷征的肿瘤易发生EGFR突变。

To investigate the correlation of clinical, pathological and multi-slice spiral computed tomography (MSCT) findings and epidermal growth factor receptor (EGFR) mutations in the patients with lung adenocarcinoma.

A total of 157 patients with lung adenocarcinoma who underwent surgery and were confirmed to suffer from peripheral lung adenocarcinoma pathologically after operation in the Department of Chest Surgery in our hospital from September 2017 to April 2018 were collected for this study. The EGFR status was respectively tested for the postoperative specimens. Two senior radiologists independently analyzed the chest preoperative MSCT within one month and evaluated the relevant factors of EGFR mutations through analyzing the clinical information and the pathological features. All the data were analyzed with Chi-squared test, Fisher′s exact test, and Student′s t test. The ROC curves were statistically analyzed. And P<0.05 was considered statistically significant.

On the CT images, the mutation rates of EGFR in the tumors with spiculation, pleural indentation and ground-glass opacity (GGO) were 65.1% (P=0.012), 64.6% (P=0.044) and 70.3% (P=0.013), respectively, and statistical significant difference was found. The mutation rates of EGFR in the tumors accounted for 68.0% in the female patients (P=0.002) and 69.2% in the non-smoking patients (P=0.000). The pathological subtypes of lung adenocarcinoma in this cohort included: acinar, lepidic, micro-papillary, papillary, solid and infiltrating mucinous subtypes, whose mutation rates of EGFR were 68.5%, 60.9%, 50.0%, 43.8%, 22.2%, and 0.0%, respectively, and statistical significant difference was found (P=0.003). Multivariate logical analysis showed that when all the significant characteristics of EGFR mutations were correlated, the AUC of the ROC curve was 0.718.

Among the patients with primary lung adenocarcinoma, EGFR mutations tend to occur in women and non-smokers. Mutations of EGFR are mostly in genes 19 and 21, which are prone to occur in the acinar type and lepidic type of lung adenocarcinoma. Mutations of EGFR often occur in the early stage of lung adenocarcinoma. In the terms of MSCT appearance, EGFR mutations more likely occur in the tumors with GGO, spiculation and pleural indentation.