晚期非小细胞肺癌中淋巴结转移与EGFR突变的相关性及对患者预后的影响

The correlation between lymph node metastasis and EGFR mutation and its potential effect on the prognosis of patients with advanced non-small cell lung cancer

目的探索晚期非小细胞肺癌中淋巴结转移与表皮生长因子受体(EGFR)突变状态的相关性及对患者总生存的预测价值。方法回顾性分析1358例晚期非小细胞肺癌患者的临床病理资料和随访资料,KaplanMeier法进行疾病总生存率(OS)分析,并采用Log-rank检验进行比较。结果吸烟与不吸烟患者、EGFR突变型与EGFR野生型患者、M1a与M1b患者的N分期间,差异均有统计学意义(P﹤0.05);淋巴结转移阴性或仅有肺门淋巴结转移患者(N_(0~1))多为不吸烟、EGFR突变型及M1a患者。Kaplan-Meier生存分析结果显示,N_(0~1)组患者总生存时间明显长于N_(2~3)组患者(P﹤0.001)。按EGFR因素分层分析显示,N_(0~1)/EGFR突变组患者的预后最好,N_(2~3)/EGFR野生组患者的预后最差,而N_(0~1)/EGFR野生组与N_(2~3)/EGFR突变组患者的生存时间比较,差异无统计学意义(P=0.642);按M分期分层分析显示,N_(0~1)/M1a组患者的预后最好,N_(2~3)/M1b组患者的预后最差,而N_(0~1)/M1b组与N_(2~3)/M1a组患者的生存时间比较,差异无统计学意义(P=0.450)。结论非小细胞肺癌中淋巴结分期与EGFR突变状态有关,N_(0~1)期患者预后明显优于N_(2~3)期患者,同时EGFR状态及M分期可进一步影响不同淋巴结分期患者的预后。

Objective To explore the correlation between lymph node metastasis and epidermal growth factor recep-tor （EGFR） mutation and its predictive value on overall survival in patients with advanced non-small cell carcinoma （NSCLC）. Method A total of 1358 cases of advanced NSCLC patients were retrospectively analyzed. Kaplan-Meier sur-vival curve was used to analyze overall survival （OS） and Log-rank test was used to calculate P values. Result The N stage were statistically correlated with smoking history, EGFR status and M stage （P〈0.05）. Negative lymph node metas-tasis or hilar lymph node metastasis （N0-1） was mostly observed in nonsmoker with EGFR mutation or at the stage of M1a. There was remarkably prolonged OS in the group of N0-1 than N2-3 as shown in Kaplan-Meier survival curve （P〈0.001）. Based on EGFR mutational status stratification, the best and worst prognosis were observed in N0-1/EGFR＋ group and N2-3/EGFR-group, respectively, however, there was no significant difference in survival time between the N0-1/EGFR-and N2-3/EGFR＋ group （P=0.642）. Based on M stage stratification, N0-1/M1a group showed the best prognosis, while the N2-3/M1b group demonstrated the worst, however, there was no significant difference in regard of survival time between pa-tients of N0-1/M1b or N2-3/M1a （P=0.450）. Conclusion There was significant correlation between N stage and EGFR muta-tional status in advanced NSCLC patients. Those with an early N stage （N0-1） seem to have a better overall survival than those with advanced ones （N2-3）. Meanwhile, EGFR status and M stage could also affect the prognosis of patients with lymph node metastasis.