From the Departments of Pulmonary and Critical Care Medicine (C.M.C., W.S.K.), Oncology (C.M.C.), Radiology and Research Institute of Radiology (M.Y.K.), and Clinical Epidemiology and Biostatistics (J.B.L.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea; and Department of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Seoul, Korea (H.J.H.).
Radiology. 2015 Apr;275(1):272-9. doi: 10.1148/radiol.14140848. Epub 2015 Jan 7.
To study the differences in computed tomographic (CT) characteristics between patients with advanced lung adenocarcinoma who have anaplastic lymphoma kinase (ALK) gene rearrangement and those who have epidermal growth factor receptor (EGFR) mutations.
This retrospective study was approved by the institutional review board. Informed consent was waived. Patients with stage IV adenocarcinoma (n = 198) were enrolled from November 2004 to December 2013, including 68 patients with ALK rearrangement and 130 with EGFR mutation. Two independent radiologists evaluated the main tumor in each patient and determined its size, type, margins, lymph node metastasis, and intrathoracic metastasis (lung, pleural or pericardial, or bone). A multiple logistic regression model was applied to discriminate clinical and CT characteristics between the types of mutation.
The κ index for assessment of tumor and node stage between radiologists was 0.8530 to 0.9388. Most of the main tumors in patients with both types of mutation appeared as solid masses. In univariate analysis, patients with an ALK rearrangement were younger (P < .001) and were more likely to be men (P = .001), to have never smoked (P = .002), and to have pleural or pericardial metastases (P < .05) compared with those with EGFR mutations. In multivariate analysis, lobulated margins (odds ratio, 4.815; 95% confidence interval [CI]: 1.789, 12.961; P = .002), N2 or N3 lymph node involvement (odds ratio, 2.445; 95% CI: 1.005, 5.950; P = .049), and lymphangitic lung metastasis (odds ratio, 8.485; 95% CI: 2.238, 32.170; P = .002) were more common in patients with ALK rearrangement than in those with EGFR mutation. The area under the receiver operating characteristic curve was 0.855.
Adenocarcinomas with ALK rearrangement appeared as solid masses with lobulated margins at CT and were more likely to be associated with lymphangitic metastasis, advanced lymph node metastasis, and pleural or pericardial metastasis than were tumors with EGFR mutations.
研究具有间变性淋巴瘤激酶（ALK）基因重排的晚期肺腺癌患者与具有表皮生长因子受体（EGFR）突变的患者之间 CT 特征的差异。
本回顾性研究经机构审查委员会批准，豁免了知情同意。2004 年 11 月至 2013 年 12 月，共纳入 198 例 IV 期腺癌患者，包括 68 例 ALK 重排患者和 130 例 EGFR 突变患者。两位独立的放射科医生评估了每位患者的主要肿瘤，并确定了其大小、类型、边界、淋巴结转移以及胸内转移（肺、胸膜或心包或骨）。采用多变量逻辑回归模型来区分突变类型之间的临床和 CT 特征。
放射科医生评估肿瘤和淋巴结分期的κ指数为 0.8530 至 0.9388。两种突变类型的大多数主要肿瘤均表现为实性肿块。在单变量分析中，ALK 重排患者较 EGFR 突变患者更年轻（P<0.001），更可能为男性（P=0.001），从不吸烟（P=0.002），且更可能发生胸膜或心包转移（P<0.05）。多变量分析显示，分叶状边界（优势比，4.815；95%置信区间[CI]：1.789，12.961；P=0.002）、N2 或 N3 淋巴结受累（优势比，2.445；95%CI：1.005，5.950；P=0.049）和淋巴管性肺转移（优势比，8.485；95%CI：2.238，32.170；P=0.002）在 ALK 重排患者中比在 EGFR 突变患者中更常见。受试者工作特征曲线下面积为 0.855。
CT 上具有 ALK 重排的腺癌表现为实性肿块，具有分叶状边界，与淋巴管转移、淋巴结转移进展以及胸膜或心包转移的相关性高于 EGFR 突变肿瘤。
