EGFR基因突变及ERCC1、RRM1表达在非小细胞肺癌精准化治疗中的应用价值  

Clinical application value of combined detection of EGFR gene mutation and ERCC1 and RRM1 expressions in precise treatment for non-small cell lung cancers

作　　者：陆如建[1] 褚红军[1] 尤庆生[2] 安超伦[1] 施海[1] 张宏飞[1] 

机构地区：[1]南通市第三人民医院胸外科,江苏226001 [2]南通大学附属医院胸外科

出　　处：《交通医学》2017年第2期115-120,共6页Medical Journal of Communications

基　　金：南通市卫生局青年基金(WQ2014034)

摘　　要：目的:通过研究非小细胞肺癌(NSCLC)患者标本中表皮生长因子受体(EGFR)基因突变以及ERCC1和RRM1表达情况,结合患者个体化临床资料,探讨其与患者临床特征、疗效及预后的相关性,为NSCLC患者精准化治疗提供理论依据。方法:收集52例同期手术治疗的NSCLC患者肿瘤组织,应用免疫组织化学法检测ERCC1和RRM1的蛋白表达,应用PCR方法检测EGFR基因突变,同时进行相关统计分析;比较不同EGFR基因突变以及不同ERCC1和RRM1的蛋白表达与患者临床特征、疗效及预后的关系。结果:(1)EGFR基因突变女性(56.5%,13/23)高于男性(20.7%,6/29)(P=0.009),腺癌(56.5%)高于鳞癌(23.1%)(P=0.017);不同TNM分期、年龄和吸烟状况下EGFR基因突变差异无统计学意义(P>0.05)。(2)ERCC1、RRM1阳性表达率分别为46.2%(24/52)、48.1%(25/52)。不同性别、年龄、病理分型、TNM分期和吸烟状况的患者其表达差异无统计学意义(P>0.05)。ERCC1和RRM1阴性表达者中位生存期(18.2M,17.3M)高于阳性表达者(13M,15M)(P=0.001、0.009)。(3)EGFR突变型患者化疗后中位生存期较EGFR野生型患者短,差异有统计学意义(P=0.027),EGFR野生型同时ERCC1、RRM1的表达阴性化疗疗效和中位生存期较突变型的好(P=0.043,P=0.0006)。结论:(1)EGFR基因突变在女性、腺癌的患者中发生率较高。(2)ERCC1、RRM1的表达水平可评价中晚期NSCLC患者以铂类为基础化疗的疗效,并可作为判断该类患者预后的指标。(3)EGFR野生型且ERCC1、RRM1的表达阴性的患者术后行以铂类为基础化疗其疗效较佳,EGFR突变型患者建议选择TKI治疗。Objective：In combination with individual clinical data of patients, EGFR gene mutation and expressions of ERCC1 and RRM1 in specimens from patients with non-small cell lung cancer （NSCLC）were detected to explore their correlations with the clinical characteristics, curative effects and prognoses of patients, and provide a theoretical basis for individualized precise treatment of patients with NSCLC. Method：The tumor tissues of 52 patients with NSCLC who under- went homochronous operative treatment were collected, the expression levels of ERCCI and RMM1 proteins were detected by immunohistochemical method, and EGFR gene mutation was detected by Polymerase Chain Reaction（PCR） method. At the same time, the relevant statistical analyses were conducted; the relationships of different EGFR gene mutations and dif- ferent expression levels of ERCC1 and RRM1 proteins with clinical characteristics, curative effects and prognoses of pa- tients were compared. Results： （1）The occurrence rate of EGFR gene mutation in females （56.5%, 13/23） was higher than that in males （20.7%, 6/29） （/9=-0.009）; The occurrence rate of EGFR gene mutation in adenocarcinonm （56.5%） was higher than that in squamous cell carcinoma （23.1%）（P=0.017）; there were no significant differences among patients with different TNM stages, age and smoking statuses （P〉0.05）.（2）The positive expression rates of ERCCI and RRM1 were 46.2% （24/52） and 48.1% （25/52） respectively, and there were no significant differences in their expressions among patients with different genders, ages, pathological types, TNM stages and smoking statuses （P〉0.05）. The median survival time in patients with negative ERCC1 and RRM1 expressions （18.2M, 17.3M） was higher than that in patients with positive ERCCIand RRMI expressions （13M, 15M）（P=0,001,0.009）.（3）The median survival time in patients with EGFR mutations was shorter than that in patients with EGFR wild type NSCLC, and there was a significant differ

关 键 词：非小细胞肺癌 表皮生长因子受体基因 ERCC1基因 RRM1基因 精准化治疗 

分 类 号：R734.2[医药卫生—肿瘤]