EGFR 19-del和L858R突变型NSCLC患者预后比较

Comparison of prognosis between EGFR 19-del and L858R mutations in patients with non-small-cell lung cancer

目的比较表皮生长因子受体(EGFR)19外显子(19-del)突变和21外显子L858R点突变型非小细胞肺癌(NSCLC)患者的预后。方法收集257例NSCLC患者,取其新鲜组织或石蜡包埋组织,采用ARMS-PCR法检测EGFR基因型。收集临床资料,定期随访,以死亡为终点事件,失访或截止至末次随访时间尚未发生终点事件均纳入截尾数据,应用SPSS17.0软件进行统计分析。结果在257例患者中,19-del突变型134例,L858R突变型123例。两种类型突变患者的临床特征分布比较,P均>0.05。生存分析结果显示,19-del突变型中位生存期为798 d,L858R突变型中位生存期为710 d,两者的总生存期差异无统计学意义(P>0.05)。进一步对样本进行分层分析结果显示,在汉族患者中,19-del突变型患者预后比L858R突变型患者好(P=0.047),在壮族中未观察到差异有统计学意义(P>0.05)。在不同年龄、性别、TNM分期和临床分期上预后也没有统计学差异(P均>0.05)。结论EGFR 19-del突变和L858R突变型NSCLC患者总体上总生存期相似,但是在汉族中EGFR 19-del型突变患者预后较好。

Objective To compare the prognosis between the epidermal growth factor receptor（ EGFR） exon 19（ 19-del） mutation and exon 21 L858R（ L858R） mutation in patients with non-small-cell lung cancer（ NSCLC）. Methods Totally 257 cases of NSCLC patients were selected. The fresh tissues or paraffin embedding tissues were obtained,and the EGFR genotypes were detected by ARMS-PCR. Meanwhile,we collected the clinical data,and the patients were followed up by using the death as the end. Patients without follow-up or the patients who did not have the outcome until the end of the follow-up were all brought into the censored data. All data were analyzed by SPSS17. 0 software. Results There were134 cases with 19-del mutation and 123 cases with L858 R mutation in 257 patients. No significant difference was found in the distribution of clinical characteristic between the two groups（ P〈0. 05）. The survival analysis showed that the median survival time of 19-del mutation was 798 d and that of L858 R mutation was 710 d,and the overall survival time had no statistical difference in these two groups（ P〈0. 05）. Subsequently,the result from the stratified analysis revealed that the prognosis in patients with 19-del mutation was better than that of L858 R mutation in Han nationality（ P = 0. 047）,and no significant difference was found in Zhuang nationality（ P〈0. 05）. Meanwhile,the overall survival time showed no statistically difference in age,gender,TNM stages and clinical stages between 19-del and L858 R mutations（ all P〈0. 05）.Conclusion The overall survival time is the same between NSCLC patients with 19-del mutation and with L858 R mutation,but the prognosis of patients with 19-del mutation is better than that of L858 R mutation in Han nationality.