晚期肺腺癌IASLC分级和Napsin A表达对EGFR-TKIs疗效及患者预后的影响  

IASLC histological classification of advanced lung adenocarcinoma and Napsin A expression on efficacy of EGFR-TKIs and prognosis in patients

作　　者：徐军 陈君平 李梦君 程兰兰 王健 XU Jun;CHEN Jun-ping;LI Meng-jun;CHENG Lan-lan;WANG Jian(Department of Pathology,the 901st Hospital of the Joint Logistics Support Force of PLA,Hefei 230031,China)

机构地区：[1]解放军联勤保障部队第九〇一医院病理科,合肥230031

出　　处：《临床与实验病理学杂志》2022年第12期1439-1444,共6页Chinese Journal of Clinical and Experimental Pathology

基　　金：第九〇一医院院管重点课题(2021YGZD02)。

摘　　要：目的 探究晚期肺腺癌IASLC分级和Napsin A蛋白表达对表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)疗效和患者预后的影响。方法 回顾性分析563例经组织学确诊为ⅢB期或Ⅳ期,且接受过EGFR突变检测的肺腺癌患者临床资料,采用免疫组化EnVision两步法检测Napsin A表达,同时选取EGFR-TKIs治疗前后均有活检配对的标本20对,观察IASLC分级和Napsin A表达在EGFR-TKIs治疗前后的变化。结果 563例肺腺癌患者Napsin A阳性456例(81.0%),Napsin A在EGFR敏感突变、低IASLC分级肺腺癌中的阳性率高于EGFR无突变、高IASLC分级肺腺癌。合计纳入125例EGFR敏感突变且接受EGFR-TKIs一线治疗患者,Napsin A阳性、低IASLC分级患者的客观缓解率高于相应对照组。Kaplan-Meier单因素分析显示:Napsin A表达、EGFR突变类型、IASLC分级均与患者中位无进展生存期(progression-free survival, PFS)和总生存期(overall survival, OS)相关;Cox多因素分析显示:Napsin A表达、IASLC分级是影响患者PFS、OS的独立因素,Napsin A表达缺失、高IASLC分级提示患者预后不良。20例接受EGFR-TKIs一线治疗的患者中3例在耐药后出现Napsin A表达缺失、IASLC分级增高。结论 IASLC分级和Napsin A表达对EGFR敏感突变患者的PFS和OS有重要影响,是预测患者接受EGFR-TKIs治疗疗效和预后的简单且有效指标。Purpose To analyze the effect of IASLC classification and Napsin A expression on efficacy of EGFR-TKIs and prognosis in patients with advanced lung adenocarcinoma harboring EGFR mutations. Methods A retrospective analysis was carried out in 563 cases of stage ⅢB or Ⅳ lung adenocarcinoma patients who received EGFR mutation test. The expression levels of Napsin A were analyzed using immunohistochemical staining, and twenty pairs of specimens were used to evaluate Napsin A expression and IASLC classification before and after acquiring resistance to EGFR-TKIs. Results Napsin A expression was positive in 456(81.0%) cases of lung adenocarcinoma. Patients with low IASLC grade and EGFR mutation showed higher expression levels of Napsin A. A total of 125 patients harboring EGFR mutations were treated with EGFR-TKIs. Either loss of Napsin A expression or high IASLC grade was associated with a poor objective response rate. In univariate analyses, Napsin A expression, IASLC classification and EGFR mutation types were significantly associated with both progression-free survival(PFS) and overall survival(OS). Multivariate analysis of survival demonstrated that the Napsin A and IASLC classification were independent prognostic factors for both PFS and OS. Of the tumours acquiring resistance to EGFR-TKIs, three cases showed the loss of Napsin A expression. Conclusions IASLC classification and Napsin A expression can be used to predict the efficacy and prognosis of EGFR-TKIs in patients with advanced lung adenocarcinoma harboring EGFR mutations.

关 键 词：肺肿瘤 腺癌 IASLC分级 Napsin A EGFR-TKIS 预后 

分 类 号：R734.2[医药卫生—肿瘤]