Correlation Between Epidermal Growth Factor Receptor Mutation And Histologic Subtypes Or Characteristics Of Computed Tomography Findings In Patients With Pulmonary Adenocarcinoma

PartI Correlation between EGFR gene mutation and histopathology in lung adenocarcinomaObjective:To investigate the correlation between EGFR gene mutation and histopathological classification in patients with invasive pulmonary adenocarcinoma.Methods:The detailed data of 624 patients with lung adenocarcinoma were retrospectively analyzed.The EGFR hotspot mutations(18,19,20,21)in lung adenocarcinoma were detected by Amplification Refractory Mutation System-Polymerase Chain Reaction(ARMS-PCR).The mutations of EGFR gene were compared with histopathological subtypes by histological typing of surgical specimens and small specimens using the new histopathological classification of lung adenocarcinoma.SPSS20.0 statistical analysis software was used to establish a database of clinical data and histopathological classification.Multivariate logistic model was used to correlate EGFR mutation with clinical features,Chi-square test and Fisher exact probability method were used to detect EGFR mutation and lung adenocarcinoma subtype,P<0.05 was statistically significant.Results:Among 459 cases of lung adenocarcinoma,201 cases(43.79%)had EGFR mutation.The mutation of EGFR gene was predominant in females(p<0.001)and non-smokers(p<0.001).The mutation rate of EGFR in surgical specimens was higher than that in EGFR,and the difference was not statistically significant(p=0.055).Histopathological subtypes of invasive adenocarcinoma were mainly acinar(APA,50.54%),solid(SPA,17.43%),adherent(LPA,13.07%),papillary(PPA,10.24%)and micropapillary(MPA,8.71%).EGFR mutation was associated with adhesiveness-predominant adenocarcinoma and micropapillary-predominant adenocarcinoma(p = 0.007 and P = 0.005).Conclusion:(l)EGFR gene mutation is more common in female and non-smoking patients,and there is no statistical correlation between EGFR gene mutation and the clinical pathological characteristics such as the origin of the tumor and tumor stage.(2)EGFR gene mutation mainly concentrated in the deletion mutation of exon 19(E19del)and the point mutation of exon 21(E21L858R),accounting for 90.54%.(3)EGFR gene mutation was found in all types of infiltrating lung adenocarcinoma,and EGFR gene mutation was associated with adherent-predominant adenocarcinoma and micropapillary-predominant adenocarcinoma in histopathological subtypes.(4)Combined with clinical features and histopathological subtypes,EGFR mutation in lung adenocarcinoma may be more helpful to predict EGFR gene mutation in lung adenocarcinoma.Part ⅡValue of HRCT features in predicting early EGFR mutation after surgical resection of early lung adenocarcinomaObjective:To retrospectively analyze the CT features and EGFR mutation of early lung adenocarcinoma after surgical resection,and to explore the value of predicting EGFR mutation by CT features of early lung adenocarcinoma.Methods:The detailed data of 208 patients with early lung adenocarcinoma who underwent surgical resection were retrospectively analyzed.The mutation of EGFR hotspot mutation gene(exon 18,19,20,21)was detected by amplification refractory mutation system(ARMS),and the CT features of EGFR gene mutation and tumor chest imaging were compared..SPSS20.0 statistical analysis software was used to establish a database of clinical data,histopathological features and chest CT features.Chi-square test and Fisher exact probability method were used to analyze the correlation between EGFR mutation and clinical features.Multivariate logistic model was used to analyze the correlation between EGFR mutation and CT features of lung adenocarcinoma.Logistic regression model was used to analyze the clinical and CT features with statistical differences.Relative risk(OR)and 95%confidence interval(CI)were calculated.The ROC curve of EGFR mutation in lung adenocarcinoma was drawn and the corresponding area under the curve(AUC)was calculated.When p<0.05 thought the difference was statistically significant.Results:There were 98 cases(47.16%)of EGFR mutation in 208 cases of lung adenocarcinoma.The mutation of EGFR gene was predominant in female(p = 0.008),non-smoking(p = 0.006)and adherent adenocarcinoma(p = 0.032).In chest CT features,EGFR gene mutations were predominant in lesions with GGO(p = 0.018)and vacuole sign/air bronchial sign(p=0.003).Multivariate analysis showed that non-smoking,adherent-predominant adenocarcinoma and GGO and vacuole/air bronchial sign were independent factors for EGFR mutation.In the multiple logistic regression model,the area under the four combined factor subject curve(ROC)was 0.746.Conclusion:GGO and air bronchial sign/vacuole in HRCT features of early lung adenocarcinoma are associated with EGFR mutation status.Clinical features combined with HRCT features are helpful to predict EGFR mutation.