肺腺癌患者中EGFR突变与肺结核的相关性研究

Relationship between EGFR mutation and pulmonary tuberculosis in lung adenocarcinoma patients

目的:研究肺腺癌患者中表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变与肺结核在肺腺癌中的相关性。方法:采用PCR扩增及基因测序方法检测506例肺腺癌患者EGFR基因突变情况,分析其与肺结核之间的关系,进一步使用Kaplan-Meier法进行生存分析并行Log-rank检验。结果:506例肺腺癌患者中有218例患者存在EGFR突变,其中25例患者有感染肺结核病史。在肺腺癌患者中,有肺结核病史的患者EGFR基因突变率,尤其是外显子21缺失显著高于单纯肺腺癌者(P=0.047,P=0.002)。肺腺癌与结核灶在同一肺叶或同侧肺的患者EGFR基因突变率明显高于二者在不同侧肺,尤其是外显子21突变(P=0.020,P=0.030)。有肺结核病史患者的2年生存率明显高于单纯肺腺癌患者(P=0.039),且在未经EGFR-TKIs治疗的具有肺结核史的患者中,EGFR突变组与野生型组相比,2年生存率无统计学差异(P=0.948),经过EGFR-TKIs治疗的患者2年生存率亦差异无统计学意义(P=0.425)。结论:肺腺癌患者中,有肺结核病史的患者EGFR基因突变发生率明显增高,且EGFR基因突变与其预后无关。

Objective：To investigate the relationship between EGFR mutations and pulmonary tuberculosis in lung adenocarcino-ma. Methods：We detected EGFR mutations in 506 patients with lung adenocarcinoma by PCR amplification and sequencing and ana-lyzed the relationship between the mutations observed and pulmonary tuberculosis. Survival analysis was performed using the Ka-plan-Meier method with log-rank tests. Result：A total of 218 patients showed EGFR mutations;of these patients, 25 had a clinical his-tory of pulmonary tuberculosis. Compared with lung adenocarcinoma patients with no history of tuberculosis, patients with a history of pulmonary tuberculosis showed higher incidence rates of EGFR mutations, especially of exon 21 （P=0.047, P=0.002）. Higher incidence rates of EGFR mutations, especially of exon 21, were observed in patients with lung cancer and tuberculosis in the same lobe or the same side of the lung than in those who had lung cancer and tuberculosis in opposite sides of the lung （P=0.02, P=0.03）. Survival analy-sis showed that adenocarcinoma patients with a history of pulmonary tuberculosis have 2-year survival rates lower than that of adeno-carcinoma patients with no history of the disease （P=0.039）. In patients adenocarcinoma associated with tuberculosis patients without EGFR-TKIs treatment, the 2-year survival rates of EGFR mutation patients and those without EGFR mutation showed no statistically significant difference （P=0.948）. At the same time, we got the same results in adenocarcinoma associated with tuberculosis patients with EGFR-TKIs treatment （P=0.425）. Conclusion：Lung adenocarcinoma patients with a history of pulmonary tuberculosis have high-er incidence rates of EGFR mutations, and EGFR mutations are not related to disease prognosis.