内科理论与实践

内科理论与实践 ›› 2025, Vol. 20 ›› Issue (04): 282-288.doi: 10.16138/j.1673-6087.2025.04.04

• 论著 • 上一篇    下一篇

SMARCA4表达缺失型非小细胞肺癌的临床与CT特点

张雪坤a, 陈晓炎b, 夏鑫芸a, 程增辉a()   

  1. a.上海交通大学医学院附属瑞金医院 放射科，上海 200025
    b.上海交通大学医学院附属瑞金医院 病理科，上海 200025
  • 收稿日期:2025-04-14 出版日期:2025-07-31 发布日期:2025-10-27
  • 通讯作者: 程增辉 E-mail: czh12048@rjh.com.cn

Clinical and CT features of non-small cell lung cancer SMARCA4 expression deficiency

ZHANG Xuekuna, CHEN Xiaoyanb, XIA Xinyuna, CHENG Zenghuia()   

  1. a. Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine,Shanghai 200025, China
    b. Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine,Shanghai 200025, China
  • Received:2025-04-14 Online:2025-07-31 Published:2025-10-27

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摘要：

目的：探讨SMARCA4 缺失型非小细胞肺癌（SMARCA4-deficient non-small cell lung cancer, SMARCA4-dNSCLC）的临床与CT影像特征。方法：回顾性收集我院2018年1月至2022年1月期间经组织病理学证实的SMARCA4-dNSCLC患者，以同期收治SMARCA4表达完整的非小细胞肺癌（SMARCA4-intact non-small cell lung cancer， SMARCA4-iNSCLC）患者作为对照组。观察并记录SMARCA4-dNSCLC的临床资料与CT表现，并与SMARCA4-iNSCLC组比较。结果：共纳入SMARCA4-dNSCLC组42例，SMARCA4-iNSCLC组43例。SMARCA4-dNSCLC组男性、吸烟者及患慢性阻塞性肺疾病者比例更高。SMARCA4-dNSCLC组较SMARCA4-iNSCLC组更易出现上腔静脉综合征，而SMARCA4-idNSCLC组更常见咯血。CT表现上，SMARCA4-dNSCLC组肿瘤密度相对更均匀，囊变、坏死及钙化更少见，边界更模糊，且伴发阻塞性肺炎/肺不张比例较低。结论：SMARCA4-dNSCLC多见于老年男性，重度吸烟者，常伴有慢性阻塞性肺疾病。病灶好发于两肺上叶。CT多表现为密度相对均匀的软组织占位，边界不清，无囊变或坏死，罕见钙化。增强后不均匀强化。纵隔淋巴结转移常见。具备上述临床与CT特征者应警惕这一独特亚型的可能。

关键词: SMARCA4表达缺失肺癌, 非小细胞肺癌, CT

Abstract:

Objective To explore the clinical and CT features of SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC ). Methods SMARCA4-dNSCLC cases confirmed histopathologically were enrolled and analyzed retrospectively in our hospital from January 2018 to January 2022. Using SMARCA4-intact NSCLC (SMARCA4-iNSCLC) cases admitted during the same period as control, the clinical characteristics and CT features of SMARCA4-dNSCLC cases were observed, recorded and compared. Results There were 42 cases in the SMARCA4-dNSCLC group and 43 cases in SMARCA4-iNSCLC control group, respectively. Compared with the control, the SMARCA4-dNSCLC group had a higher proportion of males, smokers, and chronic obstructive pulmonary disease (COPD). Clinically, the SMARCA4-dNSCLC group exhibited a higher incidence of superior vena cava syndrome, while the SMARCA4-iNSCLC group presented with hemoptysis more frequently. On CT imaging, tumors in the SMARCA4-dNSCLC group showed relatively homogeneous density, fewer cystic changes, necrosis, or calcification, more ill-defined borders, and a lower rate of associated obstructive pneumonia/atelectasis. Conclusions SMARCA4-dNSCLC was more frequently seen in elderly males and heavy smokers and was frequently accompanied by COPD. Occasionally, it could present with superior vena cava syndrome. The tumors were prone to locate in the upper lobes of both lungs. On CT imaging, it mostly presented as a soft tissue mass with relatively homogenous density, ill-defined boundaries, without cystic changes or cavities, and calcification was rare. The vast majority showed significant heterogenous enhancement after contrast. Mediastinal lymph node metastasis was common. This unique subtype of NSCLC should be considered in patients with the above clinical and CT features.

Key words: SMARCA4-deficency lung cancer, Non-small cell lung cancer, Computed tomography

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