外周血表皮生长因子受体基因检测在非小细胞肺癌疗效预测中的价值  

Value of detection of peripheral blood epidermal growth factor receptor gene mutation in predicting the therapeutic efficacy of non-small cell lung cancer

作　　者：张霞[1] 郭伟[1] 朱海波[1] 宋霞[1] 韩存芝[2] 陈飞[3] 田瑞芬[1] 

机构地区：[1]山西省肿瘤医院呼吸二病区,太原030013 [2]山西省肿瘤医院病因室,太原030013 [3]山西省肿瘤医院放疗胸部二病区,太原030013

出　　处：《肿瘤研究与临床》2018年第1期12-16,共5页Cancer Research and Clinic

摘　　要：目的 探讨外周血表皮生长因子受体（EGFR）基因检测在晚期非小细胞肺癌疗效预测中的价值.方法 收集山西省肿瘤医院2013年10月至2015年2月确诊的150例ⅢA～Ⅳ期非小细胞肺癌患者,采用突变扩增阻滞系统（ARMS）检测外周血EGFR基因,观察突变率与患者各临床病理特征之间的关系,并根据入组标准选择80例患者进入后续治疗.A组EGFR基因突变的40例患者（均为19或21外显子突变）口服吉非替尼治疗;B组EGFR基因野生型40例患者行NP方案化疗4个周期.评价两组疗效及无进展生存期.结果 EGFR基因突变率为33.3％（50/150）,其中19外显子缺失突变29例,21外显子突变18例,20外显子突变2例及18外显子突变1例.EGFR基因突变率在女性、腺癌、不吸烟患者中增高（均P〈0.05）.80例接受后续治疗患者中,A组较B组治疗有效率[67.5％（27/40）比32.5％（13/40）]及疾病控制率[85.0％（34/40）比65.0％（26/40）]均增高,中位PFS时间延长（9.00个月比4.25个月）,差异均有统计学意义（χ2=9.800,P=0.002;χ2=4.267,P=0.039;χ2=15.792,P〈0.001）.结论 外周血EGFR基因突变检测可以用于预测非小细胞肺癌酪氨酸激酶抑制剂的疗效.Objective To investigate the value of detecting peripheral blood epidermal growth factor receptor （EGFR） gene in predicting the therapeutic efficacy of advanced non-small cell lung cancer. Methods A total of 150 patients with stage ⅢA-Ⅳ non-small cell lung cancer diagnosed in Shanxi Provincial Cancer Hospital from October 2013 to February 2015 were collected. The peripheral blood EGFR gene was detected by amplification refractory mutation system （ARMS）. The relationship between the mutation rate and the clinicopathological features of patients was observed, and 80 patients were selected into the follow-up treatment according to the inclusion criteria. Forty patients （all 19 or 21 exon mutations） in group A with EGFR gene mutation were treated with gefitinib orally. Forty patients with wild type EGFR gene in group B underwent 4 cycles of NP regimen. Efficacy and progression-free survival were evaluated in both groups. Results The mutation rate of EGFR gene was 33.3 % （50 cases）, of which 29 were exon 19, 18 were exon 21 and 3 were exon 18 and 20. The mutation rate of EGFR gene was higher in female, adenocarcinoma and non-smoker （all P〈0.05）. Among the 80 patients who received follow-up treatment, the effective rate [67.5%（27/40） vs. 32.5 % （13/40）] and disease control rate [85.0 % （34/40） vs. 65.0 % （26/40）] in group A were significantly higher than those in group B, and the median PFS was prolonged （9.00 months vs. 4.25 months）,the differences were statistically significant （χ2=9.800, P=0.002;χ2=4.267, P=0.039;χ2= 15.792, P〈0.001）. Conclusion The detection of peripheral blood EGFR mutation can be used to predict the efficacy of tyrosine kinase inhibitors in non-small cell lung cancer.

关 键 词：癌 非小细胞肺 受体 表皮生长因子 基因突变 酪氨酸激酶抑制剂 

分 类 号：R734.2[医药卫生—肿瘤]