Correlation Analysis Between EGFR And ALK Mutations Between Demographic Chest CT Images Features Of In Lung Adenocarcinoma

Background:Primary bronchogenic lung cancer(referred to as lung cancer)is the most common malignant tumor with the highest morbidity and mortality in the world.The US Health Insurance Surveillance,Epidemiology,and End-Results(SEER)database shows that approximately 75%of patients have advanced at the time of treatment.Therefore,the treatment of advanced patients is an important part of the treatment system for lung cancer,and,similarly,it is also the most advanced part in recent years.Among them,the molecular classification based on genetic characteristics has advanced the treatment of advanced lung cancer into the era of individualized molecular targeted therapy.Epidermal growth factor receptor epidermal growth factor receptor(EGFR)mutation is the most common type of lung adenocarcinoma.In recent years,multiple phase III clinical trials have found that epidermal growth factor receptor kinase inhibitor(EGFR-TKI)is the preferred choice for patients with EGFR mutations.The EGFR-TKI treatment has significantly prolonged the progression-free survival,Improved life quality compared with conventional platinum-based chemotherapy regimens in gene-mutated lung adenocarcinomas.Similarly,crizotinib,a fusion inhibitor of anaplastic lymphoma kinase(ALK)gene mutations,showed good efficacy and safety in patients with advanced NSCLC who are positive for the fusion gene.In fact,there are still many patients who cannot obtain tissue specimens to complete EGFR/ALK gene mutation testing due to lack of medical conditions,high costs,and refuse of invasive examinations,which affect the prognosis of these patients.In recent years,it has been argued that there are differences in the demographic and CT image features between patients with different gene mutations.This study aims to retrospectively analyze the differences of demographic and CT image features in patients with different gene mutation status,in order to provide a reasonable reference for patients who can not get genetic tests and to improve the prognosis.Patients and Methods:Retrospective analysis the patients information who were diagnosed with lung adenocarcinoma by pathological immunohistochemistry(bronchoscopic biopsy,transcutaneous examination)in respiratory medicine,oncology,and thoracic surgery at the Second Affiliated Hospital of Nanchang University from January 2016 to July2017 and some from September 2017 to March 2018.General data、chest CT examination data before treatment,or gene mutation detection data.Patients according to gene date divided into three group:EGFR~+、ALK~+、wild group;subgroup analysis was based on the EGFR~+group:the 19 exon mutations,21 exons mutation groups.Than analyze demographic data(sex,age,smoking status),CT image feature(from mass size,uniformity,shape,margin,tumor-lung interface,etc.)total 14 features.Finally,SPSS 21.0 was used to analyze the differences between major groups and subgroups.Result:1.The EGFR~+、ALK~+and wild groupThe general data:1.There are significant differences in sex,smoking history,and median age between the EGFR~+group and the wild group(p<0.05),the EGFR~+group tend to be women、without smoke and younger;2.There are statistical differences in the smoking history between the ALK~+and the wild group,the ALK~+group tend to without smoking history;3.There are no difference in the general date between the EGFR~+and the ALK~+group.The CT features:1.Significant difference in metastasis between EGFR~+group、ALK~+group and wild group,EGFR~+and ALK~+group Predispose to premature metastasis(P<0.05);2.ALK~+group compared with the other two groups,blood vessel relations obviously(P<0.05);3.ALK~+group(N2,N3)lymphadenopathy were mostly seen compared with EGFR~+group(P<0.05);4.The other CT features have no significant difference between the three groups.2.Subgroup patientsThere was no statistical difference in demographic and all CT features between exon 19 mutations and 21 exon mutations group.Conclusion:1.The demographic characteristics of the EGFR+and ALK+groups were similar,including gender,smoking history,and average initial age.2.When the presence of EGFR and ALK mutations,the invasive ability of the lesion is stronger,and metastasis are more common at the time of initial diagnosis..3.There were some differences in demographic characteristics among the EGFR~+group,ALK~+group,and wild group.However,there were some signs of characteristic differences in CT images.When it is impossible to obtain genetic mutation detection,it is useful to speculate that EGFR/ALK has certain practical value with reference to demographic and CT image characteristics.