Clinical and CT imaging characteristics in ALK rearranged lung adenocarcinoma
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摘要:
目的分析肺腺癌中间变淋巴瘤激酶(ALK)基因与临床及CT影像特征的关系。 方法回顾性分析217例肺腺癌患者,其中ALK重排肺腺癌为ALK阳性组,根据性别及吸烟史从ALK阴性肺腺癌患者中1:1匹配为对照组,比较临床及CT影像特征,包括年龄、性别、吸烟史、分期以及位置、大小、毛玻璃改变、分叶征、毛刺征、同一肺叶结节、非同一肺叶结节、阻塞性肺炎、血管侵犯、坏死、胸膜牵拉征、支气管充气征、透亮征、淋巴结肿大、胸腔心包积液。 结果217肺腺癌患者中ALK阳性患者占12.9%(28/217),ALK阳性肺腺癌患者多见于年轻(47.93±13.68岁 vs 59.75±13.27岁,t=3.281,P=0.002)、女性(46.4% vs 28.0%,χ2=3.859,P=0.048)、非吸烟(67.9% vs 47.6%,χ2=3.995,P=0.046)患者。ALK阳性肺腺癌胸部CT影像特征中血管侵犯(39.3% vs 14.3%,χ2=4.462,P=0.035)和坏死(32.1% vs 3.6%,χ2=7.791,P=0.005)更为常见,而其他影像特征在ALK阳性及阴性肺腺癌患者间差异无系统学意义(P>0.05)。 结论年轻、非吸烟、女性且伴有血管侵犯和坏死典型CT影像特征的肺腺癌患者可能预测ALK基因阳性。 Abstract:ObjectiveTo explore clinical and CT characteristics of anaplastic lymphoma kinase (ALK)-rearranged lung adenocarcinoma. MethodsIn this retrospective study, 217 lung adeno carcinoma patients were included. Patients with ALK-rearrange were defined with ALK positive group, while the control group was matched by gender and smoking history from ALK negative lung adenocarcinoma patients. Four clinical features (age, gender, smoking history and staging) were recorded. The location, size, ground glass opacity, lobulation, spiculation, nodules in the same lobe, nodules in non-same lobe, obstructive pneumonia, vascular invasion, necrosis, pleural retraction, obstructive changes, bubble-like lucency, lymphadenopathy, pleural or pericardial effusion were analyzed. The items were compared between 28 ALK positive lung adeno carcinoma patients and ALK negative patients. ResultsIn 217 lung adeno carcinoma patients, the positive rate of ALK was 12.9%(28/217). ALK positive patients were more common in younger (47.93±13.68 years vs 59.75±13.27 years, t=3.281, P=0.002), female (46.4% vs 28.0%, χ2=3.859, P=0.048), non-smoking patients (67.9% vs 47.6%, χ2=3.995, P=0.046). Vascular invasion (39.3% vs 14.3%, χ2=4.462, P=0.035) and necrosis (32.1% vs 3.6%, χ2=7.791, P=0.005)were higher in ALK positive lung adeno patients. Other CT imaging traits of two groups was not significantly different (P>0.05). ConclusionThe patient may have ALK rearrange, whoyoung, female, non-smoking lung adenocarcinoma and accompanied with vascular invasion and necrosis in CT imaging. -
Key words:
- lung adenocarcinoma /
- anaplastic lymphoma kinase /
- tomography /
- X-ray computed
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表 1 肺腺癌胸部CT影像特征
特征 定义 分类 肿瘤位置 中央型:侵犯节段或临近支气管;周围型:侵犯亚段或更远气道 1. 中央型;2. 周围型 肿瘤大小 肺窗肿瘤的最大径,肿物(直径>30 mm),结节(直径≤30 mm) 1. 肿物;2. 结节 毛玻璃样改变 肺部不透明的模糊病灶,支气管和血管边缘清楚 1. 无;2. 有 分叶征 病变表面的一部分显示浅的波浪状结构,但与胸膜毗邻的区域除外 1. 无;2. 有 毛刺征 从结节或肿块延伸到肺实质的线性影像且未到达胸膜表面 1. 无;2. 有 同一肺叶结节 长径>4 mm的、未定性的同一肺叶结节 1. 无;2. 有 非同一肺叶结节 长径>4 mm的、未定性的不同肺叶结节 1. 无;2. 有 阻塞性改变 阻塞性炎症或肺不张 1. 无;2. 有 血管侵犯 增强显像提示血管受侵 1. 无;2. 有 坏死 肿瘤内液化的低密度区域 1. 无;2. 有 胸膜牵拉征 胸膜向肿瘤的收缩,以线性结构起源于肿瘤并延伸至胸膜表面 1. 无;2. 有 支气管充气征 肿瘤内呈放射状的充气支气管分支 1. 无;2. 有 透亮征 肿瘤内的空气衰减点 1. 无;2. 有 淋巴结肿大 短径>10 mm的胸部淋巴结 1. N0-1;2. N2;3. N3 胸腔心包积液 临近胸膜或心包膜的液性暗区 1. 无;2. 有 表 2 不同肺腺癌ALK基因状态基线特征的关系
参数 ALK阳性 ALK阴性 t/χ2 P 年龄(匹配后,岁,Mean±SD) 47.93±13.68 59.75±13.27 3.281 0.002 性别[匹配前,n(%)] 女 13(46.4) 53(28.0) 3.859 0.048 男 15(53.6) 136(72.0) 吸烟史[匹配前,n(%)] 非吸烟 19(67.9) 90(47.6) 3.995 0.046 吸烟 9(32.1) 99(52.4) 肿瘤分期[匹配后,n(%)] I-III 5(17.9) 2(7.1) 1.804 0.406 IVA 15(53.6) 15(53.6) IVB 8(28.6) 11(39.3) 表 3 ALK基因阳性及阴性肺腺癌胸部CT影像特征的比较[n=28,n(%)]
参数 ALK阳性 ALK阴性 χ2 P 肿瘤位置 中央型 11(39.3%) 10(35.7%) 0.076 0.783 周围型 17(60.7%) 18(64.3%) 肿瘤大小 肿物 16(57.1%) 13(46.4%) 0.644 0.422 结节 12(42.9%) 15(53.6%) 毛玻璃样改变 无 26(92.9%) 23(82.1%) 0.653 0.419 有 2(7.1%) 5(17.9%) 分叶征 无 20(71.4%) 20(71.4%) 0 1 有 8(28.6%) 8(28.6%) 毛刺征 无 18(64.3%) 20(71.4%) 0.327 0.567 有 10(35.7%) 8(28.6%) 同一肺叶内结节 无 14(50.0%) 12(42.9%) 0.287 0.592 有 14(50.0%) 16(57.1%) 非同一肺叶结节 无 16(57.1%) 12(42.9%) 1.143 0.285 有 12(42.9%) 16(57.1%) 阻塞性改变 无 22(78.6%) 20(71.4%) 0.381 0.537 有 6(21.4%) 8(28.6%) 血管侵犯 无 17(60.7%) 24(85.7%) 4.462 0.035 有 11(39.3%) 4(14.3%) 坏死 无 19(67.9%) 27(96.4%) 7.791 0.005 有 9(32.1%) 1(3.6%) 胸膜牵拉 无 12(42.9%) 18(64.3%) 2.585 0.108 有 16(57.1%) 10(35.7%) 支气管充气征 无 26(92.9%) 26(92.9%) 0 1 有 2(7.1%) 2(7.1%) 透亮征 无 19(67.9%) 24(85.7%) 2.504 0.114 有 9(32.1%) 4(14.3%) 淋巴结肿大 N0-1 3(10.7%) 6(21.4%) 3.038 0.219 N2 14(50.0%) 8(28.6%) N3 11(39.3%) 14(50.0%) 胸腔心包积液 无 10(35.7%) 8(28.6%) 0.327 0.567 有 18(64.3%) 20(71.4%) -
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