南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (09): 1107-.doi: 10.12122/j.issn.1673-4254.2019.09.17

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肺原位腺癌和微浸润性腺癌的影像学表现与临床病理学、分子基因特征及预后

申磊磊，林吉兴，王柏霖，徐恒亮，赵恺，张连斌   

  • 出版日期:2019-09-20 发布日期:2019-09-20

Computed tomography findings, clinicopathological features, genetic characteristics and prognosis of in situ and minimally invasive lung adenocarcinomas

  • Online:2019-09-20 Published:2019-09-20

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摘要： 目的总结分析肺原位腺癌和微浸润性腺癌的影像学表现与临床病理学、分子基因特征及预后。方法回顾性纳入2014 年1月~2019年3月在解放军总医院海南医院胸外科行手术切除后病理证实为肺原位腺癌（AIS）和微浸润性腺癌（MIA）患者， 分析其围手术期资料，区分AIS和MIA的CT影像特点，组织病理学特征，基因突变结果及预后情况。结果共纳入73例患者，其中AIS 患者25 例，MIA患者48 例，MIA组患者年龄小于AIS组（P=0.016），AIS组中有46.4%的纯磨玻璃结节（pGGOs），MIA组中有 44.4% pGGOs，并在多发GGOs方面显著多于AIS组（P=0.049）。在反映边缘特征的CT影像学方面，AIS组中患者更少出现毛 刺现象（P=0.041），其他影像特征未见明显差异。因AIS组患者行基因检测较少，在表皮生长因子受体（EGFR）基因突变方面两 组未见明确差异，Ki-67指数在2.8%的截断点亦无统计学差异，但MIA组有更多的患者Ki-67指数>2.8%。MIA组随访时间明 显短于AIS组，但均未出现复发或死亡病例。结论AIS和MIA患者在手术安全性及随访预后方面都有满意的结果，但在CT影 像特点、基因突变状态及Ki-67指数上仍存在不同。

Abstract: Objective To investigate the computed tomography findings, clinicopathological features, genetic characteristics and prognosis of in situ adenocarcinoma (AIS) and minimally invasive adenocarcinoma (MIA) of the lung. Methods We retrospectively analyzed the data including computed tomography (CT) images, histopathological findings, Ki-67 immunostaining, and genetic mutations in patients with lung adenocarcinoma undergoing surgery at our hospital between 2014 and 2019. Results Of the total of 480 patients with lung adenocarcinoma we reviewed, 73 (15.2%) had AIS (n=28) or MIA (n=45) tumors. The age of the patients with MIA was significantly younger than that of patients with AIS (P<0.02). CT scans identified pure ground-glass nodules in 46.4% of AIS cases and in 44.4% of MIA cases. Multiple GGOs were more common in MIA than in AIS cases (P<0.05), and bluured tumor margins was less frequent in AIS cases (P<0.05). No significant difference was found in EGFR mutations between MIA and AIS cases. A Ki-67 labeling index (LI) value ≥2.8% did not differentiate MIA from AIS. The follow-up time in MIA group was significantly shorter than that in AIS group, but no recurrence or death occurred. Conclusion Despite similar surgical outcomes and favorable survival outcomes, the patients with AIS and MIA show differences in terms of age, CT findings, EGFR mutations and Ki-67 LI.