非小细胞肺癌患者EGFR突变率及与临床病理关系和TKI靶向治疗效果  

Epidermal growth factor receptor mutation rate and its relationship with clinical pathology and tyrosinase inhibitor-targeted therapy effect on patients with non-small cell lung cancer

作　　者：张海涛[1] 王春[1] 张映铭[1] 王彩英[1] 方申存[1] 吴静[1] 许斌[1] 刘丹 Zhang Haitao;Wang Chun;Zhang Yingming;Wang Caiying;Fang Shencun;Wu Jing;Xu Bin;Liu Dan(Ninth Ward,Nanjing Chest Hospital,Naniing 210029,China)

机构地区：[1]江苏省南京市胸科医院九病区,210029

出　　处：《中华肺部疾病杂志（电子版）》2019年第2期175-180,共6页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：江苏省科技计划面上项目(SBE2018740476)

摘　　要：目的探讨非小细胞肺癌(NSCLC)患者表皮生长因子受体(EGFR)突变率及与临床病理关系和酪氨酸酶抑制剂(TKI)靶向治疗效果。方法选取2014年5月至2016年8月我院收治的NSCLC患者100例为研究对象,采用聚合酶链反应-直接测序法检测患者肿瘤组织EGFR基因18-21号外显子突变情况,分析EGFR突变与临床病理的关系及其突变特点,比较EGFR突变型与野生型采用TKI靶向治疗的疗效及1年生存率、2年生存率。结果本次纳入的100例NSCLC患者中共44例发生EGFR突变,EGFR突变率为44.00%; NSCLC患者EGFR突变率特点:女性高于男性,吸烟患者高于不吸烟患者,腺癌高于非腺癌,差异对比均有统计学意义(P<0.05); Logistic回归分析显示性别为女性、病理类型为腺癌是导致NSCLC患者发生EGFR突变的独立危险因素(P<0.05); EGFR突变类型包括18号外显子点突变4.54%(2/44)、19号外显子缺失突变43.19%(19/44)、20号外显子插入突变及点突变11.36%(5/44)、21号外显子点突变40.91%(18/44); EGFR突变型患者TKI治疗有效率68.18%明显高于EGFR野生型10.71%(P<0.05); EGFR突变型与野生型患者1年、2年生存率对比差异无统计学意义(P>0.05)。结论性别、病理类型是导致NSCLC患者发生EGFR基因突变的独立危险因素,对于EGFR突变型患者采用TKI靶向治疗可获得较好疗效,但2年生存率与EGFR野生型患者尚无明显差异。Objective To observe the mutation rate of epidermal growth factor receptor(EGFR)in the patients with non-small cell lung cancer(NSCLC)and its relationship with the clinical pathology and tyrosinase inhibitor(TKI)-targeted therapy effect.Methods A total of 100 NSCLC patients treated in our hospital from May 2014 to August 2016 were selected for this study.The mutations of EGFR gene 18-21 exons were detected by polymerase chain reaction(PCR)-direct sequencing.The mutation features and the relationship between EGFR mutations and the clinical pathology were analyzed.The efficacies of the mutant type and the wild type of EGFI treated with TKI-targeted therapy and their 1-year survival rate and 2-year survival rate were compared.Results EGFR mutations occurred in 44 cases,with the EGFR mutation rate of 44%among the 100 NSCLC patients.The features of the EGFR mutation rate in NSCLC patients were that females had a higher risk than males,smokers had a higher risk than non-smokers,and the patients with adenocarcinoma had a higher risk than those without adenocarcinoma(P<0.05).Logistic regression analysis showed that the gender of female and the pathological type of adenocarcinoma were independent risk factors for EGFR mutation in the NSCLC patients(P<0.05).EGFR mutation types included point mutation of exon 18 in 2 cases(4.54%),deletion mutation of exon 19 in 19 cases(43.19%),insertion mutation and point mutation of exon 20 in 5 cases(11.36%),and point mutation of exon 21 in 18 cases(40.91%).The effective rate of TKI treatment in the EGFR mutant patients was significantly higher than that in the EGFR wild type patients(68.18%vs 10.71%,P<0.05).There was no significant difference in the EGFR mutant type and wild type about 1-year and 2-year survival rates(P>0.05).Conclusion Gender and pathological type are independent risk factors for EGFR mutations in the NSCLC patients.TKI-targeted therapy has better effect in the EGFR mutant patients,but there is no significant difference in the 2-year survival rate compared with EGFR wi

关 键 词：非小细胞肺癌 表皮生长因子受体 突变率 酪氨酸酶抑制剂 靶向治疗 

分 类 号：R734.2[医药卫生—肿瘤]