摘要
目的肺癌是目前发病率第1位的肿瘤，是癌症相关死亡最重要的原因。表皮生长因子受体一酪氨酸激酶抑制剂（epidermal growth factor receptor tyrosine kinase inhibitor，EGFR—TKI）可延长患者的生存期。本研究探讨非小细胞肺癌（non-small cell lung cancer，NSCLC）患者的EGFR突变状态与临床病理特征的关系，以及TKI治疗不同基因突变NSCLC患者的预后分析。方法回顾性分析2013—09—03—2014-09—13在郑州大学第一附属医院进行EGFR检测的758例NSCLC住院患者临床资料，分析临床病理特征与突变状态的关系，并比较常见突变TKI治疗的疗效。结果758例NSCLC患者中，EGFR突变377例（49．7％），其中男性突变率为37．9％（150／396），女性为62．7％（227／362），x2=46．634，P〈0．001。〈60岁突变率为52．7％（186／353），≥60岁为47．2％（191／405），x2=2．308，P=0．074。吸烟患者突变率为55．1％（298／541），不吸烟患者为36．4％（79／217），x2=21．612，P〈0．001。腺癌突变率为54．4％（360／662），非腺癌为17．7％（17／96），x2=45．103，P〈0．001。在非腺癌中，鳞癌突变率为15．3％（9／59），腺鳞癌为54．5％（6／11），黏液表皮样癌为10．0％（1／10），其他为6．3％（1／16）。多因素Logistic回归分析显示，女性、腺癌为EGFR突变的独立危险因素，P〈0．001；而吸烟史为非独立相关因素，P=0．681。常见突变为19缺失突变（25．9％，196／758）和21点突变（20．6％，156／758）。TKI治疗19突变的中位无进展生存期（progression-free survival，PFS）为7．0个月，95％CI为6．344～7．656；21突变的中位PFS为7．7个月，95％CI为5．986～9．414；19突变的中位PFS略短于21突变，但二者之间的差异无统计学意义，x2=1．194，P=0．274。结论EGFR突变在女性、无吸烟史及腺癌患者中较高，且女性及腺癌为独立危险因素；但也应重视对鳞癌及有吸烟史患者的EGFR突变检测。TKI治疗19和21突变NSCLC患者的PFS差异无统计学意义。
OBJECTIVE Lung cancer is the most frequently diagnosed cancer and remains the leading cause of cancer-related death. Epidermal growth factor receptor tyrosine kinase inhibitior appears to improve the survival of NSCLC. We aimed to investigate the relationship between mutations of epidermal growth factor receptor gene and the clinicopathological features as well as progression-free survival time of those patients harboring common mutation treated with tyrosine kinase inhibitors. METHODS The inpatients who had the EGFR test from September 3rd 2013 to September 13th 2014 in the First Affiliated Hospital of Zhengzhou University were enrolled. The association of mutation and clinicopathological features was evaluated by two-tailed 2 tests. The progression-free survival was determined using the Kaplan-Meier method. RESULTS Of the 758 cases of non-small cell lung cancer, 377（49.7%） were found to have EGFR mutation in which the male patients was 37. 9% （150/396）, the female patients were 62.7% （227/362,Z2 =46. 634, P〈0. 001）. There was no significant difference of EGFR mutation among patients younger than 60y and elder than 60y （52.7% versus 47.2% ,x2 =2. 308, P=0. 074）. Smokers had a lower mutation rate than non-smokers （36.4% versus 55.1%, x2 = 21. 612,P〈0. 001）. There was significant difference between adenocarcinoma and non-adenocarcinoma （54.4% versus 17.7% ,x2 =45. 103,P〈0. 001）. Non-adenocarcinoma includes squamous cell carcinoma （15.3% ,9/59） ,adenosquamous carcinoma （54.5%, 6/11）, mucoepidermoid carcinoma （10.0% , 1/10） and others （6.3%, 1/16）. The multiple factors logistic models showed that the independent risk factors were female and adenocarcinoma. Common mutations were 19-del （25. 90/00） and 21 L858R （20. 6%） mutation. The median progression-free survival time of exon 19 mutation was 7.0 months （95%CI：6. 344,7. 656） while exon 21 was 7.7 months （95%CI：5. 986,9. 414） although there was no statistically significant difference between the two groups （x2=1. 194, P=0. 274）. CONCLUSIONS Female, non-smokers and adenocarcinoma have a higher EGFR mutation rate. Female and adenocarcinoma are independent risk factors, but EGFR test for squamous cell carcinoma and patients with a history of smoking should not he ignored in routine clinical work. There is no difference between the PFS of exon 19 and exon 21.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2016年第6期369-372,共4页
Chinese Journal of Cancer Prevention and Treatment
关键词
非小细胞肺癌
表皮生长因子受体
常见突变
酪氨酸激酶抑制剂
预后
non-small cell lung cancer
epidermal growth factor receptor
common mutation
tyrosine kinase inhibitor
prognosis
