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Published on: August 11, 2017
[Relationship between EGFR, ALK Gene Mutation and Imaging and Pathological Features in Invasive Lung Adenocarcinoma]
He Yang1, Zicheng Liu1, Hongya Wang1
1Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Background:
At present, the research progress of targeted therapy for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) gene mutations in lung adenocarcinoma is very rapid, which brings new hope for the treatment of advanced lung adenocarcinoma patients. However, the specific imaging and pathological features of EGFR and ALK gene mutations in adenocarcinoma are still controversial. This study will further explore the correlation between EGFR, ALK gene mutations and imaging and pathological features in invasive lung adenocarcinoma.
Methods:
A total of 525 patients with lung adenocarcinoma who underwent surgery in our center from January 2018 to December 2019 were included. According to the results of postoperative gene detection, the patients were divided into EGFR gene mutation group, ALK gene mutation group and wild group, and the EGFR gene mutation group was divided into exon 19 and exon 21 subtypes. The pathological features of the mutation group and wild group, such as histological subtype, lymph node metastasis, visceral pleural invasion (VPI) and imaging features such as tumor diameter, consolidation tumor ratio (CTR), lobulation sign, spiculation sign, pleural retraction sign, air bronchus sign and vacuole sign were analyzed by univariate analysis and multivariate Logistic regression analysis to explore whether the gene mutation group had specific manifestations.
Results:
EGFR gene mutation group was common in women (OR=2.041, P=0.001), with more pleural traction sign (OR=1.506, P=0.042), and had little correlation with lymph node metastasis and VPI (P>0.05). Among them, exon 21 subtype was more common in older (OR=1.022, P=0.036), women (OR=2.010, P=0.007), and was associated with larger tumor diameter (OR=1.360, P=0.039) and pleural traction sign (OR=1.754, P=0.029). Exon 19 subtype was common in women (OR=2.230, P=0.009), with a high proportion of solid components (OR=1.589, P=0.047) and more lobulation sign (OR=2.762, P=0.026). ALK gene mutations were likely to occur in younger patients (OR=2.950, P=0.045), with somking history (OR=1.070, P=0.002), and there were more micropapillary components (OR=4.184, P=0.019) and VPI (OR=2.986, P=0.034) in pathology.
Conclusions:
The EGFR and ALK genes mutated adenocarcinomas have specific imaging and clinicopathological features, and the mutations in exon 19 or exon 21 subtype have different imaging features, which is of great significance in guiding the clinical diagnosis and treatment of pulmonary nodules.
Insights
Lung adenocarcinoma with epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) gene mutations show distinct imaging and pathological features. These specific characteristics aid in diagnosing and treating pulmonary nodules, guiding personalized patient care.
Area of Science:
- Oncology
- Radiology
- Genetics
Background:
- Targeted therapies for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) gene mutations offer new hope for advanced lung adenocarcinoma.
- Specific imaging and pathological features of EGFR and ALK mutations in lung adenocarcinoma remain subjects of ongoing research and debate.
- This study investigates the correlation between EGFR, ALK gene mutations, and their associated imaging and pathological characteristics in invasive lung adenocarcinoma.
Purpose of the Study:
- To explore the relationship between EGFR and ALK gene mutations and specific imaging and pathological features in lung adenocarcinoma.
- To identify distinct imaging and clinicopathological characteristics associated with EGFR (exon 19 and 21 subtypes) and ALK gene mutations.
- To provide insights for guiding clinical diagnosis and treatment strategies for pulmonary nodules based on genetic mutation status.
Main Methods:
- Retrospective analysis of 525 lung adenocarcinoma patients who underwent surgery.
- Patients were categorized into EGFR mutation, ALK mutation, and wild-type groups based on postoperative gene detection.
- Univariate and multivariate logistic regression analyses were used to compare pathological features (histological subtype, lymph node metastasis, VPI) and imaging features (tumor diameter, CTR, lobulation, spiculation, pleural retraction, air bronchus, vacuole signs) between groups.
Main Results:
- EGFR mutations were associated with female patients and the pleural traction sign. Exon 21 subtype linked to older age, female sex, larger tumor diameter, and pleural traction sign. Exon 19 subtype associated with female sex, high solid component proportion, and lobulation sign.
- ALK mutations were more frequent in younger patients with a smoking history, and associated with micropapillary components and visceral pleural invasion (VPI).
- EGFR mutations showed limited correlation with lymph node metastasis and VPI.
Conclusions:
- Lung adenocarcinomas with EGFR and ALK gene mutations exhibit specific imaging and clinicopathological features.
- Distinct imaging features differentiate EGFR exon 19 and exon 21 subtypes.
- These findings are significant for guiding the clinical diagnosis and treatment of pulmonary nodules.
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