Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Cancer Imaging. 2019 Nov 29;19(1):77. doi: 10.1186/s40644-019-0261-1.
Kirsten rat sarcoma viral oncogene homolog (KRAS) and epidermal growth factor receptor (EGFR) are the two most frequent and well-known oncogene of lung adenocarcinoma. The purpose of this study is to compare the characteristics measured with dual-energy spectral computed tomography (DESCT) in lung adenocarcinoma patients who have KRAS and EGFR gene mutations.
Patients with surgically resected lung adenocarcinoma (n = 72) were enrolled, including 12 patients with KRAS mutations and 60 patients with EGFR mutations. DESCT quantitative parameters, including the CT number at 70 keV, the slopes of the spectral attenuation curves (slope λ HU), normalized iodine concentration (NIC), normalized water concentration (NWC), and effective atomic number (effective Z), were analyzed. A multiple logistic regression model was applied to discriminate clinical and DESCT characteristics between the types of mutations.
The KRAS mutation was more common in people who smoked than the EGFR mutation. Nodule type differed significantly between the KRAS and EGFR groups (P = 0.035), and all KRAS mutation adenocarcinomas were solid nodules. Most DESCT quantitative parameters differed significantly between solid nodules and subsolid nodules. CT number at 70 keV, slope λ HU, NIC, and effective Z differed significantly between the KRAS and EGFR groups (P = 0.006, 0.017, 0.013 and 0.010) with solid lung adenocarcinoma. Multivariate logistic analysis of DESCT and clinical features indicated that besides smoking history, the CT value at 70 keV (OR = 0.938, P = 0.009) was significant independent factor that could be used to differentiate KRAS and EGFR mutations in solid lung adenocarcinoma.
DESCT would be a potential tool to differentiate lung adenocarcinoma patients with a KRAS mutation from those with an EGFR mutation.
Kirsten 大鼠肉瘤病毒致癌基因同源物（KRAS）和表皮生长因子受体（EGFR）是肺腺癌中最常见和最著名的两个致癌基因。本研究旨在比较 KRAS 和 EGFR 基因突变的肺腺癌患者的双能光谱 CT（DESCT）测量特征。
纳入了 72 例手术切除的肺腺癌患者，包括 12 例 KRAS 基因突变患者和 60 例 EGFR 基因突变患者。分析 DESCT 定量参数，包括 70keV 下的 CT 值、光谱衰减曲线斜率（斜率λHU）、标准化碘浓度（NIC）、标准化水浓度（NWC）和有效原子序数（有效 Z）。应用多因素逻辑回归模型来区分两种突变类型的临床和 DESCT 特征。
KRAS 突变更常见于吸烟者，而 EGFR 突变则更常见于不吸烟者。KRAS 和 EGFR 组之间的结节类型差异有统计学意义（P=0.035），所有 KRAS 突变腺癌均为实性结节。大多数 DESCT 定量参数在实性结节和部分实性结节之间差异有统计学意义。70keV 下的 CT 值、斜率λHU、NIC 和有效 Z 在 KRAS 和 EGFR 组之间差异有统计学意义（P=0.006、0.017、0.013 和 0.010），与实性肺腺癌相关。DESCT 和临床特征的多因素逻辑分析表明，除了吸烟史外，70keV 下的 CT 值（OR=0.938，P=0.009）是区分 KRAS 和 EGFR 突变的重要独立因素。
DESCT 可能是一种区分 KRAS 突变和 EGFR 突变肺腺癌患者的潜在工具。
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