肺癌病人EGFR基因突变与相关病理和临床特征分析

    Analysis of the relationship between EGFR gene mutation, and related pathological and clinical features in lung cancer patients

    • 摘要:
      目的分析肺癌病人表皮生长因子受体(EGFR)基因突变与临床病理特征的关系。
      方法选取70例晚期或局部晚期不能手术肺癌病人,通过肺穿刺或支气管镜活检采集组织标本,采用PCR技术检测EGFR基因突变情况,并根据检测结果分为突变组、无突变组;均给予尼妥珠单抗与多西紫杉醇+顺铂化疗联合治疗;分析2组年龄、性别、吸烟史、分化程度、组织学分型、淋巴结转移、肿瘤直径等特征信息,进行多因素logistic回归分析,并比较2组疾病控制率(DCR)。
      结果外周血、活检组织标本检测EGFR基因突变率均为42.86%(30/70),具有良好一致性;突变组与无突变组在年龄、性别、吸烟史、分化程度、组织学分型分布方面差异均有统计学意义(P < 0.01),在淋巴结转移、肿瘤直径分布方面差异无统计学意义(P>0.05)。年龄>50岁肺癌病人EGFR基因突变率高于≤ 50岁者(P < 0.01);女性肺癌病人EGFR基因突变率高于男性(P < 0.01);无吸烟史肺癌病人EGFR基因突变率高于有吸烟史者(P < 0.01);无分化、低中分化、高分化肺癌病人EGFR基因突变率差异明显,且分化程度越高,突变率越高(P < 0.01);腺鳞癌、腺癌肺癌病人EGFR基因突变率高于大细胞癌、鳞癌(P < 0.01)。多因素分析显示,EGFR基因突变与分化程度、组织学分型独立相关(P < 0.05和P < 0.01)。EGFR突变组疗效明显优于无突变组(P < 0.01)。
      结论EGFR基因突变多发于第19号、21号外显子,且多见于年龄>50岁、女性、无吸烟史、分化程度较高、腺鳞癌、腺癌肺癌病人,肿瘤分化程度、组织学分型与EGFR基因突变独立相关,存在EGFR基因突变病人DCR较高,有利于临床靶向治疗的筛选。

       

      Abstract:
      ObjectiveTo analyze the relationship between the mutation of epidermal growth factor receptor (EGFR) gene and clinicopathological features in patients with lung cancer.
      MethodsThe tissue samples in seventy patients with advanced or locally advanced inoperable lung cancer were collected by lung puncture or bronchoscopy biopsy, and the EGFR gene mutations were detected using polymerase chain reaction (PCR).According to the test results, the patients were divided into the mutation group and no mutation group, and two groups were treated with nituzumab combined with docetaxel and cisplatin.The age, sex, smoking history, degree of differentiation, histological type, lymph node metastasis and tumor diameter characteristics were analyzed using multivariate logistic regression model, and the disease control rate (DCR) was compared between two groups.
      ResultsThe mutation rates of EGFR gene in both peripheral blood and biopsy specimen were 42.86% (30/70), and the consistency was good.The differences of age, sex, smoking history, degree of differentiation and histological type between two groups were statistically significant (P < 0.01), and the differences of lymph node metastasis and tumor diameter between two groups were not statistically significant (P>0.05).The mutation rate of EGFR gene in patients aged older than 50 years was higher than that in patients younger than 50 years (P < 0.01).The mutation rates of EGFR gene in female patients with lung cancer and patients without smoking history were higher than that in males and patients with smoking history, respectively (P < 0.01).The differences of the mutation rate of EGFR among patients with non-differentiated, low-differentiated and high-differentiated lung cancer were significant, and the higher the degree of differentiation was, the higher the mutation rate was (P < 0.01).The mutation rates of EGFR gene in patients with adenosquamous carcinoma and adenocarcinoma were higher than that in patients with large cell carcinoma and squamous cell carcinoma (P < 0.01).The results of multivariate analysis showed that EGFR gene mutation was independently related to the differentiation degree and histological type (P < 0.05 and P < 0.01). The efficacy in EGFR mutation group was significantly better than that in no mutation group (P < 0.01).
      ConclusionsEGFR gene mutations are frequently found in exons 19 and 21, and most of them are in women over 50 years old, the female, no smoking history, high differentiation, adenosquamous carcinoma, adenocarcinoma, degree of tumor differentiation and histological classification are independently related to EGFR gene mutation.The DCR of patients with EGFR gene mutation is high, which is conducive to the screening of clinical targeted therapy.

       

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