Relationship between CT imaging features of non-small cell lung cancer and expression of Ki-67 and vascular endothelial growth factor
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摘要:
目的 分析非小细胞肺癌（NSCLC）CT影像特征与Ki-67、血管内皮生长因子（VEGF）的表达关系，为NSCLC的临床诊治及判断预后提供理论依据。 方法 回顾性收集我院2018年1月~2023年1月112例确诊为NSCLC的患者，采用Philips Brilliance 256iCT检查患者CT影像特征，检测NSCLC组织中Ki-67、VEGF的表达，分析影像特征、临床资料（病理类型、性别、年龄、吸烟史）与Ki-67、VEGF表达水平的关系。 结果 CT特征与Ki-67表达关系中，出现毛刺征、深分叶征、动脉期强化CT值≥ 20 Hu、静脉期强化CT值≥20 Hu、肺门淋巴结肿大、直径≥3 cm，Ki-67阳性表达率高（P < 0.05）；出现钙化、胸膜牵拉征，Ki-67阳性表达率低（P < 0.05）；其余指标差异无统计学意义(P>0.05)。CT特征与VERF表达关系中, 出现血管集束征、动脉期明显强化≥20 Hu、直径≥3 cm、肺门淋巴结肿大，VEGF阳性表达率高(P < 0.05)；出现空泡征、深分叶征、直径 < 3 cm，VEGF阳性表达率低（P＜0.05）。临床资料与Ki-67、VEGF表达关系中，男性、有吸烟史、患者中Ki-67阳性表达率高，病理类型为鳞癌Ki-67阳性表达率低，差异有统计学意义（P < 0.05）；VEGF表达与临床资料组间差异均无统计学意义（P>0.05）。 结论 NSCLC患者的CT影像特征与Ki-67、VEGF中的表达状态密切相关，一定程度上可推测免疫组化指标表达情况。 Abstract:Objective To explore the relationship between CT imaging features of non-small cell lung cancer (NSCLC) and the expression of Ki- 67 and vascular endothelial growth factor (VEGF), providing a theoretical basis for the clinical diagnosis, treatment, and prognosis of NSCLC. Methods A retrospective analysis of 112 patients diagnosed with NSCLC in our hospital from January 2018 to January 2023. Philips Brilliance 256iCT was used to examine CT imaging features, and the expression of Ki-67 and VEGF in NSCLC tissues was detected. The relationship between imaging features, clinical data (pathological type, gender, age, smoking history), Ki- 67 and VEGF expression levels was analyzed. Results In the relationship between CT features and Ki-67 expression, the presence of spiculation sign, deep lobulation sign, arterial phase enhancement CT value ≥20 Hu, venous phase enhancement CT value ≥20 Hu, enlargement of mediastinal lymph nodes and diameter ≥3 cm was associated with a high Ki- 67 positive expression rate (P < 0.05). The presence of calcification and pleural traction sign was associated with a low Ki- 67 positive expression rate (P < 0.05). Other indicators showed no statistical significance. In the relationship between CT features and VEGF expression, the presence of vessel convergence sign, significant enhancement in the arterial phase ≥20 Hu, diameter ≥3 cm, and enlargement of mediastinal lymph nodes was associated with a high VEGF positive expression rate (P < 0.05). The presence of air bronchogram sign, deep lobulation sign, and diameter < 3 cm was associated with a low VEGF positive expression rate (P < 0.05). In the relationship between clinical data and Ki-67 and VEGF expression, males, those with a smoking history, and a high Ki-67 positive expression rate in patients, and a low Ki-67 positive expression rate in squamous cell carcinoma, were statistically significant (P < 0.05). There was no statistical difference in VEGF expression between different clinical data groups (P>0.05). Conclusion CT imaging features in NSCLC patients are closely related to the expression of Ki-67 and VEGF, providing a certain predictive value for immunohistochemical marker expression. -
Key words:
- CT features /
- non-small cell lung cancer /
- Ki-67 /
- vascular endothelial growth factor
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图 1 典型病例
Figure 1. Typical cases. A: Pleural traction and burr; B: Air bronchus; C: Deep lobulated; D: Vascular cluster; E: Sign of cavitation.
图 2 CT征像诊断Ki-67（A）和VEGF（B）的ROC曲线分析
Figure 2. ROC curve analysis of CT signs in the diagnosis of Ki-67 (A) abd VEGF (B).
表 1 Ki-67、VEGF与CT特征间的统计学分析
Table 1. Statistical analysis of Ki-67, VEGF and CT features [n(%)]
Index Ki-67 VEGF Positive Negative χ2 P Positive Negative χ2 P Gender 30.097 ＜0.001 0.676 0.411 Female 21(36.84) 36(63.16) 24(42.11) 33(57.89) Male 48(87.27) 7(12.73) 19(34.55) 36(65.45) Age (year) 0.141 0.707 0.707 0.428 ≥60 36(60.00) 24(40.00) 21(35.00) 39(65.00) ＜60 33(63.46) 19(36.54) 22(42.31) 30(57.69) Smoking history 20.133 0.001 1.966 0.161 No 28(43.75) 36(56.25) 21(32.81) 43(67.19) Yes 41(85.42) 7(14.58) 22(45.83) 22(45.83) Vessel convergence sign 0.193 0.356 10.262 0.002 No 33(53.22) 29(46.77) 12(24.19) 40(64.51) Yes 36(72.00) 14(28.00) 31(62.00) 19(38.00) Spicule sign 12.986 ＜0.001 1.391 0.149 No 30(55.56) 24(44.44) 14(25.93) 40(74.07) Yes 13(22.41) 45(77.59) 29(50.00) 29(50.00) Deep lobulation sign 9.618 0.001 9.727 0.002 No 22(52.38) 20(47.62) 14(33.33) 28(66.67) Yes 47(67.14) 23(32.86) 29(41.43) 41(58.57) Bubble sign 3.139 0.094 32.471 ＜0.001 No 14(37.83) 23(62.16) 28(75.68) 9(24.32) Yes 55(73.33) 20(26.66) 15(20.00) 60(80.00) Air bronchogram 1.396 1.396 3.525 0.06 No 33(88.00) 17(12.00) 24(48.00) 26(52.00) Yes 36(40.32) 26(59.68) 19(30.65) 43(69.35) Pleural traction sign 18.882 ＜0.001 0.028 0.866 No 37(89.47) 1(0.026) 15(39.47) 23(60.53) Yes 32(43.24) 42(56.75) 28(37.84) 46(62.16) Calcification 24.972 ＜0.001 1.812 0.328 No 39(90.70) 4(9.30) 22(51.16) 21(48.84) Yes 30(43.48) 39(56.52) 21(30.43) 48(69.57) Diameter 5.144 0.023 23.671 0.001 ≥3 cm 47(70.15) 20(29.85) 38(56.72) 29(43.28) ＜3 cm 22(48.89) 23(51.11) 5(11.11) 40(88.89) Boundary 2.123 0.142 2.21 0.137 Blur 36(72.00) 14(28.00) 23(46.00) 27(54.00) Clarity 33(53.23) 29(46.77) 20(32.26) 42(67.74) CT value in arterial phase 23.12 ＜0.001 1.022 0.004 ≥20 Hu 67(71.28) 27(28.72) 56(59.57) 38(40.43) ＜20 Hu 2(11.11) 16(88.89) 2(27.78) 13(72.22) CT value in venous phase 9.551 ＜0.001 0.028 0.868 ≥20 Hu 54(63.53) 31(36.47) 33(38.82) 52(61.18) ＜20 Hu 15(55.56) 12(44.44) 10(37.04) 17(62.96) Lymphadenectasis 9.388 0.002 11.626 ＜0.001 No 43(75.44) 14(24.56) 52(91.22) 5(0.087) Yes 26(47.27) 29(52.73) 34(61.81) 21(38.18) 
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表 2 Ki-67、VEGF与病理类型间的关系
Table 2. Relationship between Ki-67, VEGF and pathological types [n(%)]
Pathological type (%) Ki-67 VEGF Positive Negative Positive Negative Adenocarcinoma 18(45.00) 22(55.00) 20(50.00) 20(50.00) Squamous carcinoma 21(29.17) 51(70.83) 23(31.94) 49(68.06) χ2 29.334 0.865 P ＜0.001 0.194
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表 3 组间差异有统计学意义征像与Ki-67表达的二元Logistic回归分析
Table 3. Binary Logistic regression analysis of signs with statistically significant differences between groups and Ki- 67 expression
Item Regression coefficient Standard error Z Wald χ2 P OR Gender -4.550 1.410 -3.227 10.415 0.001 0.011 Deep lobulation sign 0.315 0.315 5.166 3.216 ＜0.001 1.165 Lymphadenectasis -1.164 0.916 -1.272 1.618 0.203 0.312 Pathological pattern 0.293 0.656 3.941 3.136 0.001 3.568 Spicule sign 1.514 0.315 1.549 2.399 0.121 4.119 Sign of cavitation -4.932 1.188 -4.153 17.250 0.001 0.007 Pleural traction sign -1.636 1.035 -1.557 2.423 0.120 0.200 Calcification -1.516 0.836 -1.881 3.537 0.060 0.217 Diameter(cm) -3.493 0.964 -3.683 13.563 ＜0.001 0.029 CT value in arterial phase -2.201 1.048 -2.100 4.410 0.036 0.111 CT value in venous phase -0.124 0.747 -0.165 0.027 0.869 0.884 Intercept 13.658 3.219 3.155 13.315 ＜0.001 3213.914
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表 4 CT征像与Ki-67的AUC曲线分析
Table 4. AUC curve analysis of CT signs and Ki-67
Item AUC Standard error P 95% CI Gender 0.573 0.056 0.194 0.463-0.683 Deep lobulation sign 0.766 0.047 ＜0.001 0.675-0.858 Types of pathology 0.248 0.046 ＜0.001 0.159-0.337 Lymphadenectasis 0.351 0.054 0.008 0.246-0.456 Sign of burr 0.675 0.053 0.008 0.246-0.456 Sign of cavitation 0.289 0.048 ＜0.001 0.194-0.383 Pleural traction sign 0.300 0.049 ＜0.001 0.204-0.397 Calcification 0.264 0.047 ＜0.001 0.171-0.356 Diameter(cm) 0.392 0.055 0.055 0.283-0.501 CT value in arterial phase 0.328 0.056 0.002 0.219-0.438 CT value in venous phase 0.469 0.057 0.584 0.358-0.580
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表 5 组间差异有统计学意义的征像与VEGF表达的二元Logistic回归分析
Table 5. Binary Logistic regression analysis of signs with statistically significant differences between groups and VEGF expression
Item Regression coefficient Standard error Z Wald χ2 P OR Vessel convergence sign -1.023 0.555 -1.844 3.399 0.065 0.360 Deep lobulation sign -0.171 0.572 -0.298 0.089 0.766 0.843 Sign of cavitation -2.615 0.615 -4.255 18.103 ＜0.001 0.073 Diameter cm -2.712 0.677 -4.008 16.065 ＜0.001 0.066 Intercept 9.107 2.080 4.378 19.171 ＜0.001 9015.803
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表 6 CT征像与VEGF的AUC曲线分析
Table 6. AUC curve analysis of CT signs and VEGF
Headline AUC Standard error P 95% CI Vessel convergence sign 0.345 0.053 0.006 0.242-0.449 Deep lobulation sign 0.540 0.056 0.477 0.431-0.650 Sign of cavitation 0.240 0.050 ＜0.001 0.142 -0.337 Diameter cm 0.268 0.048 ＜0.001 0.175 -0.362
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