| PART 1 THE VALUE OF CT AND CLINICAL FEATURES IN PREDICTING EGFR MUTATION IN LUNG ADENOCARCINOMAObjective To explore the value of clinical and computed tomography(CT)features of lung adenocarcinoma(LADC)in predicting epidermal growth factor receptor(EGFR)mutations.Methods Data of 803 patients with solitary LADC confirmed by pathology from February 2012 to October 2018 who received chest CT and EGFR gene test were retrospectively analyzed.All cases were divided into EGFR mutation positive group(426 cases,53.05%)and negative group(377 cases,46.95%),and the differences of clinical and CT characteristics between the two groups were compared.Combined with the above clinical and CT features with statistical differences,a Logistic regression model was established,and the area under the curve(AUC)was used to determine the effectiveness of the model in predicting EGFR mutations.Results(1)For clinical characteristics in 803 cases,there was no statistical differences in age and clinical stage between the two groups(p >0.05),while the rates of EGFR mutation were significantly higher in women and non-smokers than those in men and smokers(all p < 0.001).(2)For CT characteristics,the rates of EGFR mutation were significantly higher in tumor with smaller size,peripheral,maximum tumor diameter < 3cm,ground-glass opacity(GGO),air bronchogram sign,burr sign,pleural traction sign,vascular cluster sign,pleural effusion,necrosis,intrathoracic lymph nodes and multiple pulmonary metastases(p<0.05),while those were lower in tumor with necrosis,pleural effusion and lymphadenopathy.In 608 enhanced cases,significant difference was observed between the two groups in △CT value of venous phase(p<0.05).(3)Logistic regression analysis showed that women,non-smokers,GGO,air bronchogram sign,pleural traction sign,vascular cluster sign,and multiple pulmonary metastases might be independent predictors of EGFR gene mutation.ROC curve analysis showed that the AUC was 0.771,and the sensitivity and specificity of predicting EGFR gene mutation in isolated LADC were 74.8% and 68.5%,respectively.Conclusion The clinical and CT features of patients with LADC have important predictive value for EGFR mutation status.PART 2 COMPARISON OF CLINICAL,PATHOLOGICALAND CT FEATURES OF EGFR EXON19 AND 21 MUTATIONS IN LUNG ADENOCARCINOMAObjective To investigate the clinical,pathological and CT characteristics of lung adenocarcinoma(LADC)patients with EGFR 19 and 21 exon mutations.Methods Clinical,pathological and imaging data of 683 patients with LADC in our hospital from December 2012 to December 2020 were retrospectively analyzed.According to the gene mutation status,patients were divided into EGFR 19 exon mutation group(165,24.2%),EGFR 21 exon mutation group(217,31.8%),EGFR negative mutation group(301,44.1%).The clinical,pathological and CT features were compared between EGFR common loci(exons 19 & 21)mutation group and EGFR negative mutation group,EGFR exon 19 and 21 mutation group.Results(1)Comparison between EGFR common loci mutation group and EGFR negative mutation group: in clinical characteristics:women and non-smokers were more common in the EGFR common loci mutation group,while men and smokers were more common in the EGFR negative mutation(all p<0.05);for pathological features,the proportion of solid-dominated growth pattern in EGFR negative mutation group was higher than that in EGFR common loci mutation group(p<0.05);among CT features,peripheral distribution,spiculation,ground-glass opacity(GGO),air bronchogram,vascular convergence sign,pleural retraction and multiple lung metastases were more common in the EGFR common loci mutation group,while the maximum diameter of tumor ≥3cm,pleural effusion,necrosis and lymph node metastasis were more common in the EGFR negative mutation group(all p<0.05).(2)Comparison between EGFR exon 19 group and EGFR exon 21 mutation group: in clinical features,the proportion of women in EGFR exon 19 mutation group was higher than that in EGFR exon 21 mutation group(p<0.05);for pathological features,the proportion of acinar-dominated growth pattern in EGFR exon 21 mutation group was higher than that in EGFR exon 19 mutation group(p<0.05);among CT features,the incidences of peripheral distribution,vascular convergence sign and pleural retraction in EGFR exon 21 mutation group were higher than those in EGFR exon 19 mutation group(all p < 0.05).Conclusion There are some differences in the clinical,pathological,and CT features of patients with EGFR negative mutations,EGFR exon 19 and exon 21 mutations in LADC.To be familiar with these differences is helpful for the individualized treatment of patients with unknown gene mutation status of LADC.PART 3 USING COMBINED CT-CLINICAL RADIOMICS MODELS TO IDENTIFY EPIDERMAL GROWTH FACTOR RECEPTOR(EGFR)-MUTATION SUBTYPES IN LUNG ADENOCARCINOMAObjective To investigate the value of computed tomography(CT)-based radiomics signatures in combination with clinical and CT morphological features to identify epidermal growth factor receptor(EGFR)-mutation subtypes in lung adenocarcinoma(LADC).Methods From February 2012 to October 2019,608 patients confirmed with LADC and underwent chest CT scans were included.Among them,307(50.5%)patients had a positive EGFR-mutation and 301(49.5%)had a negative EGFR-mutation.Of the EGFR-mutant patients,114(37.1%)had a 19del-mutation,155(50.5%)had a L858R-mutation,and 38(12.4%)had other rare mutations.Three combined models were generated by incorporating radiomics signatures,clinical,and CT morphological features to predict EGFR-mutation status.Patients were randomly assigned to the training and validation cohorts in a ratio of 8:2 for each model.Model 1 was used to predict positive and negative EGFR-mutation,model2 was used to predict 19 del and non-19 del mutations,and model 3 was used to predict L858 R and non-L858 R mutations.The receiver operating characteristic curve(ROC)and the area under the curve(AUC)were used to evaluate their performances.Results For model 1,the AUCs for predicting EGFR-mutation positive cases were 0.969 and 0.886 in the training and validation cohorts,respectively.The accuracy,sensitivity,and specificity of the validation cohort were 0.810,0.902,and 0.717,respectively.For model 2,the AUC values for predicting 19del-mutation were 0.999 and 0.847 in the training and validation cohorts,respectively.The accuracy,sensitivity,and specificity in the validation cohort were 0.852,0.739,and 0.879,respectively.For model 3,the AUCs for predicting L858R-mutation were0.984 and 0.806 in the training and validation cohorts,respectively.The accuracy,sensitivity,and specificity in the validation cohort were 0.713,0.879,and 0.652,respectively.Conclusion Combined models incorporating radiomics signature,clinical,and CT morphological features may serve as an auxiliary tool to predict EGFR-mutation subtypes and contribute to individualized treatment for patients with LADC.PART 4 RADIOLOGICAL CLASSIFICATION,GENE-MUTATION STATUS,AND SURGICAL PROGNOSIS OF SYNCHRONOUS MULTIPLE PRIMARY LUNG CANCERObjective To investigate the radiological classification,gene-mutation status,and surgical prognosis of synchronous multiple primary lung cancer(s MPLC).Methods From January 2013 to October 2019,192 consecutive patients with s MPLC were investigated.The clinical,CT,molecular,and pathological features were analyzed.Furthermore,prognosis of 89 patients who only underwent surgical resection were evaluated.Results Among 192 patients,all lesions pathologically confirmed or highly suspected as tumors based on radiological findings were retrospectively analyzed,and the CT findings of s MPLC were classified into three types: I)all lesions manifested as solid nodules/masses(14.1%,27/192),II)all lesions manifested as subsolid nodules/masses(43.2%,83/192),and Ⅲ)tumor lesions manifested as a combination of ≥2 of the following patterns: solid nodules/masses,subsolid nodules/masses,cystic airspace,and focal consolidation(42.7%,82/192).The rate of epidermal growth factor receptor(EGFR)-mutation was higher in subsolid tumors than that in solid tumors(p < 0.05).Among 19 patients with all tumors undergoing surgery and nine driver-gene testing,12 patients(63.2%)had tumors with different gene-mutation statuses.The highest clinical stage of non-I,ipsilateral distribution of tumors,and CT classification of I indicated poor prognosis for patients with s MPLC(all p < 0.05).Conclusion Tumors of s MPLC were usually manifested as subsolid seldom as solid.Subsolid tumors had a high incidence of EGFR,and tumors of the same patient with different gene-mutation status were more common.The highest clinical stage,location,and radiological classification may serve as prognostic factors for s MPLC. |
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