摘要
目的探讨EGFR基因突变对非小细胞肺癌(NSCLC)患者临床特征,预后的价值,揭示总生存期(OS)≥3年的生存特点。方法回顾性分析2013年1月1日至2018年6月30日南京医科大学附属肿瘤医院接受个体化治疗的349例NSCLC患者临床资料。对应收集石蜡包埋组织标本,采用HRM法,检测组织中EGFR基因第18、19、20、21外显子的突变状态,分析EGFR基因突变与患者临床病理参数的相关性。Kaplan-Meier方法和χ2分析随访资料完整的249例患者EGFR基因突变对生存的影响,揭示OS≥3年生存影响因素。结果在349例NSCLC肺癌患者中,EGFR基因突变率为50.4%,EGFR基因主要高突变人群是女性(62.2%)和腺癌患者(52.0%),<60岁易发生19突变(28.9%),≥60岁(32.0%)和女性(37.8%)易发生21突变,差异具有统计学意义(P<0.05)。EGFR18、20、双突变和临床特征之间无统计学意义(P>0.05)。截至2018年12月15日,249例随访完整的患者中,中位生存时间为23个月。EGFR基因的总突变和21突变,与野生型相比较,能显著提高无进展生存期(PFS)和OS,差异具有统计学意义(P<0.05)。EGFR18、19、20、双突变的PFS生存率,与野生型相比较,差异不具有统计学意义(P>0.05)。OS≥3年和OS≤1年的患者在性别、TNM分期、淋巴结转移、EGFR总突变率、21的突变率及靶向治疗率方面差异有统计学意义(P<0.05)。结论EGFR基因的总突变和21突变的患者均能明显延长生存期。
Objective To investigate the clinical characteristics and prognosis of non-small cell lung cancer(NSCLC)patients with EGFR mutation,and to reveal the survival characteristic of the overall survival≥3 months.Methods The clinical data of 349 NSCLC patients treated with individualized therapy were retrospectively analyzed from 2013-01-01 to 2018-06-30 in Affiliated Tumor Hospital of Nanjing Medical University.HRM method was used to detect the mutation of EGFR gene 18,19,20,and 21 exons in the tissue.The correlations between EGFR gene mutation and clinic pathological parameters were analyzed.Kaplan-Meier method andχ2 analysis were used to follow up 249 cases of EGFR gene mutation on survival,revealing the factors affecting the survival of OS≥3 years.Results The mutation rate of EGFR gene was 50.4%in 349 NSCLC using HRM method.The mutation of EGFR gene was significantly associated with females(62.2%)and adenocarcinoma(52.0%).<60 years old was prone to the mutation of EGFR gene 19(28.9%).≥60 years old(32.0%)and females(37.8%)were prone to the mutation of EGFR gene 21.EGFR 18,20,double mutation and clinical features had no statistical significance(P>0.05).Up to December 152018,the median survival time of 249 patients who completed the follow-up was 23 months.The total mutation and 21 mutation of the EGFR gene significantly increased PFS and OS compared to wild types significantly(P<0.05).The PFS survival rates of EGFR 18,19,20,and double mutation were not statistically significant compared with wild types(P>0.05).Compared with OS≥3 years and OS≤1 year,there were statistically significant differences in gerder,TNM stage,lymph node metastasis,total EGFR mutation rate,21 mutation rate and targeted treatment rate(P<0.05).Conclusions Patients with both total and 21 mutation of EGFR gene can significantly prolong the period of survival.
作者
冒学莲
杨翊柠
汤珣
竺明晨
王承霞
陈艳
严枫
MAO Xuelian;YANG Yining;TANG Xun;ZHU Mingchen;WANG Chengxia;CHEN Yan;YAN Feng(Department of Clinical Laboratory,Affiliated Cancer Hospital of Nanjing Medical University/Jiangsu Cancer Hospital/Jiangsu Institute of Cancer Research,Nanjing 210009,China;Department of Pathology,Affiliated Cancer Hospital of Nanjing Medical University/Jiangsu Cancer Hospital/Jiangsu Institute of Cancer Research,Nanjing 210009,China)
出处
《中国肿瘤外科杂志》
CAS
2020年第3期192-197,共6页
Chinese Journal of Surgical Oncology
基金
国家自然科学基金(81871718)
江苏省医学创新团队暨领军人才基金(CXTDA2017017)。
关键词
基因突变
非小细胞肺癌
表皮生长因子受体
HRM
生存分析
Gene mutation
Non-small cell lung cancer
Epidermal growth factor receptor
High resolution melting method
Survival analysis
