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

doi:10.16138/j.1673-6087.2025.04.04

Abstract

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

CLC Number:

R734.2

ZHANG Xuekun, CHEN Xiaoyan, XIA Xinyun, CHENG Zenghui. Clinical and CT features of non-small cell lung cancer SMARCA4 expression deficiency[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(04): 282-288.

Figures/Tables 6

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References 11

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项目	SMARCA4-dNSCLC组（n=42）	SMARCA4-iNSCLC组（n=43）	t/χ²	P
年龄（岁）	60.67±8.91	63.43±8.28	0.856	0.396
年龄范围[n（%）]			2.33	0.127
<30 岁	0（0）	0（0）
30~50 岁	4（9.52）	1（2.33）
>50 岁	38（90.48）	42（97.67）
性别[n(%)]			5.695	0.017
男性	38（90.48）	30（69.77）
女性	4（9.52）	13（30.23）
吸烟史[n(%)]	36（85.71）	20（46.51）	14.58	<0.001
COPD[n(%)]	31（73.81）	12（27.91）	16.37	<0.001
咳嗽[n(%)]	33（78.57）	38（88.37）	2.27	0.132
胸痛[n(%)]	9（21.43）	10（23.26）	0.08	0.777
呼吸困难[n(%)]	12（28.57）	11（25.58）	0.09	0.765
胸闷气短[n(%)]	8（19.05）	13（30.23）	2.08	0.150
上腔静脉综合征[n(%)]	4（9.52）	0（0）	4.04	0.044
咯血[n(%)]	2（4.76）	8（18.60）	4.73	0.030
上腹痛[n(%)]	1（2.38）	0（0）	1.04	0.310

CT特征	SMARCA4-dNSCLC组（n=42）	SMARCA4-iNSCLC组（n=43）	t/χ²	P
肿瘤位置			3.54	0.470
左肺上叶	14（33.33）	12（27.91）
左肺下叶	6（14.29）	7（16.28）
右肺上叶	17（40.48）	15（34.88）
右肺中叶	0（0）	3（6.98）
右肺下叶	5（11.90）	6（13.95）
肿瘤大小(mm)	44.0±21.2	44.0±22.6	0.064	0.950
肿瘤密度[n (%)]
不均匀	17（40.48）	35(81.40)	14.73	<0.00 1
均匀	25（59.52）	8(18.60)	15.23	<0.010
病灶边缘不清晰/毛糙[n (%)]	42（100.00）	39(90.70)	4.03	0.045
病灶囊变/坏死[n (%)]	0（0）	7(16.28)	6.57	0.010
病灶钙化[n (%)]	2（4.76）	9(20.93)	4.73	0.030
强化均匀度[n (%)]
不均匀	30（93.75）	38(88.37)	0.12	0.730
均匀	2（6.25）	5(11.63)	1.58	0.208
包绕血管[n (%)]	9（21.43）	10(23.26)	0.09	0.760
累及食管[n (%)]	3（7.14）	1(2.33)	1.07	0.300
COPD[n (%)]	11（26.19）	23(53.49)	6.53	0.010
肺不张[n (%)]	10（23.81）	19(44.19)	4.73	0.030
纵隔淋巴结转移[n (%)]	27（64.29）	23(53.49)	1.17	0.280
胸腔积液[n (%)]	13（30.95）	14(32.56)	0.03	0.860

转移部位	SMARCA4-dNSCLC组（n=42）	SMARCA4-iNSCLC组（n=43）	t/χ²	P
远处转移	12（28.57）	15(34.88)	0.33	0.56
脑	6（14.29）	8(18.60)
骨	5（11.90）	4(9.30)
肾上腺	2（4.76）	3(6.98)
肝	1（2.38）	3(6.98)
颈部淋巴结	1（2.38）	2(4.65)

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