非小细胞肺癌EGFR基因突变及与疗效的相关性研究  

EGFR mutations are closely associated with Gefitinib response in non-small cell lung cancer patients

作　　者：刘宁[1] 张康[2] 颜淑霞[1] 贾雪峰[1] 陈文明[1] 张宾[1] 林凡忠[3] 胡伟[1] 聂学诚[1] 

机构地区：[1]济宁市第一人民医院肿瘤科,山东济宁272100 [2]济宁市第一人民医院胸外科,山东济宁272100 [3]济宁市第一人民医院病理科,山东济宁272100

出　　处：《现代肿瘤医学》2013年第2期330-333,共4页Journal of Modern Oncology

基　　金：济宁市科技发展计划[编号:科技字(2010)85号2-3]

摘　　要：目的:研究晚期非小细胞肺癌(NSCLC)患者表皮生长因子受体(EGFR)基因突变情况,探讨其与NSCLC临床病理学特征及吉非替尼疗效的关系。方法:PCR扩增和基因测序的检测60例NSCLC患者EGFR基因第18、19、20和21外显子突变情况。靶向治疗组14例吉非替尼治疗;化疗组46例以GP方案(顺铂联合吉西他滨方案)治疗。结果:60例晚期NSCLC中,EGFR基因突变率30.00%,19外显子突变12例,21外显子突变6例。腺癌、无吸烟史和女性患者EGFR基因突变率分别为36.89%、50.00%和57.14%。14例EGFR突变阳性患者口服吉非替尼组,CR 1例,PR 10例,SD 2例和PD 1例,客观有效率为78.57%,疾病控制率为92.85%;4例EGFR突变阳性患者GP方案化疗组,CR 0例,PR 2例,SD 2例和PD 0例,客观有效率为50.00%。42例EGFR突变阴性GP方案化疗组,客观有效率为38.10%。结论:晚期NSCLC患者EGFR基因突变率较高,EGFR基因的突变与肿瘤的病理类型、性别、年龄、民族、吸烟指数相关。EGFR基因突变KTI治疗,可有效提高患者的疾病缓解率,并较好地预测TKI治疗晚期非小细胞肺癌的疗效。Objective：To study the relationship between EGFR mutational status and Gefitinib response in non - small cell lung cancer （ NSCLC）, providing guidance of therapeutic selection for late - stage NSCLC patients. Methods： We used PCR and sanger sequencing to identify somatic mutations in exons 18,19,20,and 21 of the EGFR gene among sixty late - stage NSCLC patients. Accordingly, the patients were treated with either Gefitinib or chemotherapy of gemcitabine and eisplatin. Results： Among the sixty late - stage NSCLC patients, we found eighteen （ 30.0% ） EGFR mutations, distributed zero in exon 18, twelve in exon 19, zero in exon 20, and six in exon 21. Additionally, the EGFR mutations existed much more frequently, 36.8% , 50.0% , and 57.1% in adenocarcinoma, non - smoker, and female patients. Furthermore, therapy response was examined. When Gefitinib was used in fourteen patients with EGFR mntations,CR 1 case,PR 10 cases,SD 2 cases and PD 1 case,showing 78.6% efficacy. However,when chemotherapy was applied to the remaining four patients with EGFR mutations, zero case was CR, two were PR, two were SD, and zero was PD, showing 50.0% efficacy. As for the forty - two patients without EGFR mutations, chemotherapy showed 38.1% efficacy. Conclusion： EGFR mutations are much more frequent in adenocarcinoma, non - smoker, and female patients. Gefitinib therapy is more effective to NSCLC patients with EGFR mutations.

关 键 词：非小细胞肺癌 EGFR突变 络氨酸激酶抑制剂(TKI) 

分 类 号：R734.2[医药卫生—肿瘤]