本文關鍵詞： 肺腺癌 表皮生長因子受體 計算機體層成像 磨玻璃影 組織學分型　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討周圍型肺腺癌表皮生長因子受體(EGFR)基因突變與其CT上磨玻璃影(GGO)成分含量、病理表現(xiàn)的相關性。材料與方法:回顧性分析245例經術后病理證實的周圍型肺腺癌的影像及臨床資料,男75例,女170例,年齡27-81歲,平均年齡60.3歲。運用擴增阻滯突變系統(tǒng)(ARMS)檢測腺癌組織的EGFR基因突變情況,包括外顯子18點突變、外顯子19缺失突變、外顯子20插入突變以及外顯子21點突變;腫瘤的病理組織學分型依據2015年世界衛(wèi)生組織(WHO)公布的肺腺癌新分類進行劃分;利用西門子Somatom Definition Flash CT后處理工作站測量腫瘤GGO成分的體積比(即GGO成分占腫瘤總體積的百分比)并分為四型,分別為Ⅰ型(0GGO≤25%)、Ⅱ型(25%GGO≤50%)、Ⅲ型(50%GGO≤75%)及Ⅳ型(75%GGO≤100%);測量腫瘤最大橫斷面長徑(D)并分為六組,分別為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基因突變狀態(tài)在性別、吸煙情況、病理分型、腫瘤大小、CT上GGO含量分型中的差異采用卡方檢驗,P0.05具有統(tǒng)計學意義;EGFR基因突變狀態(tài)與腫瘤CT上GGO體積比的趨勢分析采用趨勢卡方檢驗,P0.01具有統(tǒng)計學意義。結果:女性患者中EGFR基因突變率(81.2%)及外顯子21突變率(50.6%)均高于男性患者(65.3%、36.0%),P0.05。非吸煙患者中EGFR基因突變率(81.0%)及外顯子21突變率(51.5%)均高于吸煙患者(55.6%、22.2%),P0.05。EGFR基因突變狀態(tài)在不同病理分型中的差異具有統(tǒng)計學意義,浸潤性粘液腺癌EGFR基因突變率(0%)顯著低于非浸潤性粘液腺癌(79.2%),P0.05;以貼壁生長為主的腺癌外顯子21突變率(65.8%)高于非貼壁生長為主的腺癌(37.3%),P0.05;以貼壁生長為主的腺癌外顯子19突變率(13.2%)低于非貼壁生長為主的腺癌(29.0%),P0.05。EGFR基因突變狀態(tài)在腫瘤D不同分組中的差異無統(tǒng)計學意義,P0.05。外顯子21、19突變率在不同GGO含量分型中的差異均具有統(tǒng)計學意義,P0.05;Ⅳ型的外顯子21突變率(57.7%)高于Ⅰ型(29.6%),P0.0083,其余各型間兩兩比較均無統(tǒng)計學差異;Ⅱ型的外顯子19突變率(40.9%)高于Ⅳ型(15.3%),P0.0083,其余各型間兩兩比較均無統(tǒng)計學差異。外顯子21、19突變率均與腫瘤CT上GGO體積比存在一定趨勢關系,且具有統(tǒng)計學意義(P0.01)。結論:在含有GGO成分的周圍型肺腺癌中,其性別、吸煙情況、病理類型及CT上GGO體積比對于預測EGFR基因突變類型有一定的價值。EGFR基因突變及外顯子21突變常見于女性、非吸煙患者。浸潤性粘液腺癌極少發(fā)生EGFR基因突變,外顯子21突變常見于以貼壁生長為主的腺癌。隨著腫瘤在CT上GGO成分含量的增加,外顯子21突變的幾率隨之升高,而外顯子19突變的幾率隨之降低。
[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″鎰忎箟,嫻告鼎鎬х矘娑茶吅鐧孍GFR鍩哄洜紿佸彉鐜，

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