背景:表现为磨玻璃结节(GGNs)的早期肺腺癌越来越多地被检测到,但在不同风险人群中,对以GGN为特征的肺腺癌的筛查和诊断没有达成一致.
目的:分析临床,病态,不同风险组的高分辨率计算机断层扫描(HRCT)上的GGN特征肺腺癌的影像学和遗传特征。
方法:包括华西医院经HRCT手术诊断为肺腺癌的GGNs患者,四川大学2009-2021年,病态,成像和基因测序数据。
结果:根据中国肺癌筛查和治疗专家共识,1,800例具有GGN特征的肺腺癌患者,545名男性(包括。269名吸烟者)和1,255名女性(包括。16名吸烟者),分为高危(509)和非高危(1,291)组。其中,通过体格检查发现1,095。诊断时的平均年龄为54.78(23-84),从检测到诊断的平均时间为9.59个月。高危人群中男性多于女性[288(56.58%)vs221(43.42%)],在非高风险组中正好相反[1,034(80.09%)vs257(19.91%)](均P<0.001)。GGN检测办法无统计学差别(P>0.05)。高危人群中浸润性腺癌的发病率较高,而在非高危组中,前兆病变和微创腺癌的比例更高(均P<0.001)。非高危组术前随访时间较短(P<0.05)。在473例患者中观察到总共711个基因突变,非高风险与高风险的比率为494:217。EGFR突变发生率无统计学意义(P=0.824)。而TP53和KRAS基因突变在高危人群中明显增高(P<0.05)。
结论:以GGN为特征的肺腺癌以非高危女性患者为主。非高危组术前随访时间较短,且GGN检测方式无统计学差异,提示现有高危人群筛查标准可能不适合GGN特征肺癌。此外,在高危人群中,KRAS和TP53突变的发生率较高.
BACKGROUND: Early stage lung adenocarcinomas manifested as ground-glass nodules (GGNs) are increasingly being detected, but screening and diagnosis for GGN-featured lung adenocarcinomas in different risk populations reach no agreement.
OBJECTIVE: To analyze the clinical, pathological, imaging and genetic features of GGN-featured lung adenocarcinomas on high-resolution computed tomography (HRCT) in different risk groups.
METHODS: Include patients with GGNs on HRCT surgically diagnosed as lung adenocarcinoma in the West China Hospital, Sichuan University from 2009 to 2021, and their clinical, pathological, imaging and gene sequencing data.
RESULTS: According to Chinese Expert Consensus on Screening and Management of Lung Cancer, 1,800 patients with GGN-featured lung adenocarcinoma, 545 males (incl. 269 smokers) and 1,255 females (incl. 16 smokers), were divided into high-risk (509) and non-high-risk (1,291) groups. Among them, 1,095 were detected via physical examination. The mean age at diagnosis was 54.78 (23-84) and the mean time from detection to diagnosis was 9.59 months. There were more males than females in the high-risk group [288 (56.58%) vs 221 (43.42%)], just the opposite in the non-high-risk group [1,034 (80.09%) vs 257 (19.91%)] (both P < 0.001). No statistical difference was found in GGN detection way (P > 0.05). The frequency of invasive adenocarcinoma was higher in the high-risk group, while those of precursor lesions and minimally invasive adenocarcinoma were higher in the non-high-risk group (all P < 0.001). The preoperative follow-up time in the non-high-risk group was shorter (P < 0.05). A total of 711 gene mutations were observed in 473 patients with a ratio of non-high-risk to high-risk of 494:217. The incidence of EGFR mutation was not statistically significant (P = 0.824), while those of TP53 and KRAS mutations were higher in the high-risk group (P < 0.05).
CONCLUSIONS: GGN-featured lung adenocarcinoma is dominated by non-high-risk female patients. Shorter preoperative follow-up in the non-high-risk group and no statistical difference in GGN detection way suggests the existing screening criteria for high-risk population may not suit GGN-featured lung cancer. In addition, the incidences of KRAS and TP53 mutations are higher in the high-risk group.