晚期肺腺癌患者表皮生长因子受体基因状态与骨转移的关系

Relationship between epidermal growth factor receptor gene status and bone metastasis in patients of advanced lung adenocarcinoma

目的探讨晚期肺腺癌患者表皮生长因子受体（EGFR）基因状态与骨转移的关系。方法纳入331例晚期肺腺癌患者，采用突变特异性扩增系统（ARMS）检测其EGFR基因状态，依据EGFR基因状态将其分为突变型组173例和野生型组158例，比较两组患者的临床资料，并对突变型组和野生型组及不同基因突变中有无骨转移患者进行生存分析。结果突变型组中19号外显子缺失突变91例（52．6％），21号外显子L858R突变68例（39．3％），其他少见突变14例（8．1％）。突变型组所有骨转移及骨转移数量≥3个的患者比例均高于野生型组，有吸烟史、肾上腺转移及骨转移数量为1个的患者比例均低于野生型组（P〈0．05），而两组间骨转移数量为2个的患者比例比较，差异无统计学意义（P〉0．05）。突变型组碱性磷酸酶水平高于野生型组（P〈0．05）。155例骨转移患者的中位生存时间短于176例无骨转移者（14．7个月比16．8个月，P〈0．05）。突变型组、野型生组、19号外显子缺失突变、21号外显子L858R突变中骨转移患者的中位生存时间均短于无骨转移者（P〈0．05）。结论EGFR基因突变型晚期肺腺癌患者骨转移发生率高。肺腺癌骨转移患者中位生存时间短，预后较差。

Objective To investigate the relationship between epidermal growth factor receptor （EGFR） gene status and bone metastasis in patients of advanced lung adenocarcinoma. Methods The EGFR gene status of 331 patients with advanced lung adenocarcinoma were detected by mutant specific amplification system （ARMS）. According to EGFR gene status, they were divided into the mutant type group（ 173 cases） and wild type group（ 158 cases）. Clinical data of two groups were compared. Survival analyses were performed in patients with and without bone metastasis between mutation type group and wild type group as well as different gene mutations. Results There were 91 patients （52.6%） with exon 19 deletion mntation,68 patients（39.3% ） with exon 21 L858R mutation and 14 patients（ 8.1% ） with other rare mutations in mutation type group. The proportion of patients with total bone metastasis and whose number of bones metastases was more than three in mutation type group were all higher than those in wild type group, proportion of patients with smoking history, adrenal metastasis and whose number of bone metastasis was one were all lower than those in wild type group （ P 〈 0.05 ）, but there was no significant difference of the proportion of patients whose number of bones metastases was two between the two groups （ P 〉 0.05 ）. Level of alkaline phosphatase in mutation type group was higher than that in wild type group （P 〈0.05）. Median survival time of 155 patients with bone metastasis（ 14.7 months） was shorter than that of 176 patients without bone metastasis （ 16.8 months, P 〈 0.05 ）. Median survival time of patients with bone metastasis in mutant type group, wild group, exon 19 deletion mutation and 21 exon L858R mutation were shorter than those without bone metastasis （ P 〈 0.05 ）. Conclusion Patients of advanced lung adenocarcinoma with EGFR mutant have a high incidence of bone metastasis. The median survival time of patients of advanced lung adenocarcinoma with bone metastasis is short and the prognosis is poor