表皮生长因子受体基因突变对非小细胞肺癌根治性术后化疗效果的影响

Influences of gene mutations of epidermal growth factor receptor on the efficacy of postoperative chemotherapy in non-small-cell lung cancer patients after radical surgery

目的:检测非小细胞肺癌(NSCLC)根治术后患者表皮生长因子受体(EGFR)基因突变率,探讨突变型和野生型患者辅助化疗疗效及毒性反应差异。方法:收集术后NSCLC组织,以ARMS法行EGFR基因检测;高危IB-IIIA期患者接受标准含铂两药化疗;化疗后随访18个月,定期行全身检查。结果:40例组织中检出突变19例,总突变率47.5%。突变率:鳞癌22.2%;腺癌68.2%;女72.7%,男37.9%。辅助化疗28例,副反应表现为胃肠反应及骨髓抑制。突变组DFS6个月为100%,12个月为100%,18个月为90.9%;野生组DFS6个月为70.6%,12个月为47.1%,18个月为35.3%。结论:NSCLC患者EGFR突变率腺癌较鳞癌高;女性较男性高。术后EGFR突变组较野生组辅助化疗12个月及18个月DFS高,而副反应无差异。

Objective To detect the gene mutations of epidermal growth factor receptor （EGFR） of non- small-cell lung cancer （NSCLC） patients after radical surgery, and to explore the differences of efficacy and toxicity of adjuvant chemotherapy between mutant and wild type patients. Methods NSCLC tissues were collected and the gene of EGFR was detected by ARMS. Patients at stage ⅠB-ⅢA underwent standard chemotherapy containing platinum. All patients were followed-up for 18 months and reeieved systemic examination regularly. Results 19 cases with EGFR gene mutation were found in 40 cases of tissues （47.5%）, and the EGFR gene mutation rates in squamous carcinoma, adenocarcinoma, female and male were 22.2%, 68.2%, 72.7% and 37.9%, respectively. 28 patients underwent adjuvant chemotherapy, and the major side effects were gastrointestinal reactions and bone marrow suppression. DFS in mutant group vs. wild type group in 6 months, 12 months and 18 months were 100% vs. 70.6%, 100% vs. 47.1%, and 90.9% vs. 35.3%. Conclusion The EGFR gene mutation rate of adenocarcinoma was higher than that of squamous carcinoma, and that of female was higher than that of male. After radical surgery and postoperative adjuvant chemotherapy, DFS of mutant patients in 12 and 18 months were higher than those of wild type patients, while there were no difference of toxicity between them.