肺癌组织样本和血液样本EGFR基因检测对比研究  

Comparative detection of the EGFR gene in lung adenocarcinoma tissues and blood samples

作　　者：邓会岩 刘畅 贾迎[1] 李芳[1] 尹丹静 檀紫瑞 苏冰 刘月平[1] DENG Huiyan;LIU Chang;JIA Ying;LI Fang;YIN Danjing;TAN Zirui;SU Bing;LIU Yueping(Department of Pathology,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011;Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011;Maternal and Child Health Hospital of Ningjin County,Xingtai 055550,Hebei,China)

机构地区：[1]河北医科大学第四医院病理科,河北石家庄050011 [2]河北医科大学第四医院胸外科,河北石家庄050011 [3]河北省宁晋县妇幼保健院,河北邢台055550

出　　处：《癌变．畸变．突变》2023年第1期21-25,共5页Carcinogenesis,Teratogenesis & Mutagenesis

基　　金：河北省卫生健康委医学科学研究课题计划项目(20230143)。

摘　　要：目的:研究肺腺癌患者不同样本EGFR基因检测结果的异同,以更精准地反映患者体内EGFR突变情况。方法:收集2016年7月—2017年12月收治的Ⅲ~Ⅳ期经病理确诊为肺腺癌患者175例,175例均有血浆样本,其中119例同时有活检组织样本,12例同时有胸水沉渣细胞样本。采用突变扩增系统(ARMS)-聚合酶链式反应(PCR)方法对收集到的活检组织样本、胸水沉渣细胞样本和血液样本进行EGFR基因检测,分析不同类型样本间结果的差异,以及与患者临床病理指标的关系。结果:联合检测的EGFR基因突变总阳性率较单纯血液样本阳性率提高了8.6%,较单纯组织样本提高了3.1%。EGFR突变在不同的性别(χ^(2)=3.451,P=0.045)、肿瘤直径(χ^(2)=8.911,P=0.002)、T分期(χ^(2)=17.567,P=0.000)、淋巴结转移(χ^(2)=18.511,P=0.000)、转移站数(χ^(2)=3.341,P=0.047)和远处转移(χ^(2)=10.874,P=0.001)组间的差异有统计学意义。将血液和组织两组样本EGFR突变率进行比较,差异有统计学意义(P=0.000)。在患者临床病理指标与生存时间的分析中,肿瘤直径[95%CI(0.151,0.725),P=0.006]、淋巴结转移[95%CI(0.180,0.865),P=0.020]、远处转移[95%CI(0.097,0.612),P=0.003]均是影响患者无进展生存期的重要因素。结论:肺癌患者血液样本、活检组织样本、胸水沉渣细胞样本在EGFR检测过程中的联合应用能够获得更高的检出率,可为临床更多地筛选出适合EGFR-酪氨酸激酶抑制剂(TKIs)治疗的人群。对于女性患者、肿瘤直径≥3 cm、T4期、淋巴结转移且超过3站、远处转移患者检测到血液EGFR基因突变的几率更高。其中肿瘤直径≥3 cm、淋巴结转移、远处转移患者的无进展生存期更短。OBJECTIVE:To detect expression of the EGFR gene in lung adenocarcinomas so as to understand EGFR gene mutation in patients.METHODS:From July 1,2016 to December 1,2017,a total of 175 patients with stage III-IV lung adenocarcinomas who were admitted to our hospital were collected.Among them,all patients provided blood samples,119 provided tissue biopsy samples,175 provided plasma samples and 12 provided pleural fluid sediment cell samples.EGFR gene detection was performed on these samples using ARMS-PCR.Differences in results among the different types of samples and their relationships with patients’clinicopathological data were analyzed.RESULTS:Detection of EGFR gene expression was conducted on all blood and tissue samples.The total positive rate was 8.6%higher in the tissues than in that of blood samples and 3.1%higher than that in paraffin block tissues.EGFR mutation was found in different sex(χ~2=3.451,P=0.045),tumor size(χ~2=8.911,P=0.002),T stage(χ~2=17.567,P=0.000),lymph node metastasis(χ~2=18.511,P=0.000),metastasis station(χ~2=3.341,P=0.047)and distant metastasis(χ~2=10.874,P=0.001).EGFR mutation rates in blood and tissue samples were compared,and the difference was statistically significant(P=0.000).Tumor size[95%CI(0.151,0.725),P=0.006],lymph node metastases[95%CI(0.180,0.865),P=0.020],distant metastases[95%CI(0.097,0.612),P=0.003]were important factors affecting progression-free survival.CONCLUSION:The combined application of samples from different tissues was useful in enhancing detection of EGFR gene expression.In addition,higher detection rate can increase the number of patients who are suitable for EGFR-tyrosine kinase inhibitors(TKIs)treatment in clinical practice.For female patients,the incidence of blood EGFR mutation was higher in those with tumor diameter≥3 cm,stage T4,lymph node metastases with more than 3 stations,and distant metastases.Patients with tumor diameter≥3 cm,lymph node metastasis and distant metastasis had shorter progression-free survival.

关 键 词：肺腺癌 EGFR基因 血液样本 活检组织样本 胸水沉渣细胞样本 对比研究 

分 类 号：R365[医药卫生—病理学]