肺腺癌EGFR突变及与TTF-1、CK7、NapsinA蛋白表达的关系

Relationship Between EGFR Mutation and TTF-1,CK7,Napsin A Protein Expression in Lung Adenocarcinoma

[目的]探讨新分类肺腺癌中EGFR突变情况与TTF-1、CK7、NapsinA表达的关系及临床意义。[方法]收集南京市胸科医院2013-2015年外科手术切除标本307例,根据2011年IASLC/ATS/ERS肺腺癌国际多学科新分类进行病理分型,用ARMS法检测EGFR基因,用免疫组化法检测TTF-1、CK7、NapsinA蛋白的表达。[结果]EGFR在肺腺癌中突变率为51.1%(157/307),19外显子缺失突变(del)和21外显子(L858R)突变率分别为43.9%和51.0%,乳头和实体型腺癌突变率分别为65.4%和 29%。EGFR突变与性别、吸烟及肺腺癌病理分型均有相关性(P<0.001),与TTF-1、CK7蛋白表达有相关性(均P<0.05),与NapsinA相关性(P=0.108)。[结论]EGFR基因突变多见于女性非吸烟患者,较少见于实体为主型肺腺癌,突变以21(L858R)和19外显子缺失突变为主,TTF-1蛋白表达及肺腺癌病理分型对EGFR突变有着较好的提示作用。

[Objective] To investigate the relationship between EGFR mutation and protein expression of TTF-1,CK7,NapsinA in patients with lung adenocarcinoma and its clinical significance. [Methods] A total of 307 patients with lung adenocarcinoma underwent surgical resection from 2013 to 2015 in Nanjing Chest Hospital,the tumors were classified according to the 2011 international multidisciplinary IASLC/ATS/ERS classification. The mutations of EGFR gene were detected by the amplification refractory system method,the expression of TTF-1,NapsinA and CK7 proteins was detected by immunohistochemistry. [Results] There were 157 cases of EGFR mutations in 307 cases of lung adenocarcinoma(51.1%). The mutation rates of 19 exon deletion and 21 exon(L858 R) were 43.9% and 51.0%,respectively; the mutation rate of papillary and solid predominant adenocarcinoma were 65.4% and 29% respectively. EGFR mutation was associated with gender,smoking and pathological type of lung adenocarcinoma(P<0.001),it was correlated with the expression of TTF-1,CK7 protein and was not correlated with the expression of Napsin A protein(all P<0.05). [Conclusion] EGFR mutations are more common in female non-smoking patients and less common in solid predominant lung adenocarcinoma,mutations in 21 exon(L858 R) and 19 exon deletion are dominated. TTF-1 protein expression and pathological type of lung adenocarcinoma may indicate EGFR mutation.