非小细胞肺癌驱动基因与临床病理及预后的关系

Relationship between driving genes and clinical pathology and prognosis in non-small cell lung cancer

目的探讨非小细胞肺癌(NSCLC)驱动基因改变情况与临床病理、治疗效果及预后的关系。方法选取2012年4月至2014年4月于上海长海医院诊治且病例资料完整的162例非小细胞肺癌患者作为研究对象,采用Taqman-ARMS法检测所有患者驱动基因表皮生长因子受体(EGFR)、间变淋巴瘤激酶(ALK)、c-ros原癌基因1受体酪酸激酶(ROS1)、MET基因受体酪氨酸激酶(MET)改变情况,并分析其与一般情况(性别、吸烟与否)、临床病理(病理类型、分化情况及TNM分期)、治疗及预后之间的关系。结果 NSCLC患者中EGFR的总突变率为34.57%,ALK和ROS1融合基因的总阳性率分别为9.88%和12.35%,Met基因总扩增率为6.17%。EGFR突变在患者是否吸烟、分化情况及TNM分期上差异均有统计学意义(P<0.05);ALK融合基因的阳性表达在患者是否吸烟和TNM分期上差异均有统计学意义(P<0.05);Met的阳性表达在患者的分化情况上差异有统计学意义(P<0.05);而ROS1融合基因的阳性表达在临床基本资料上差异无统计学意义(P>0.05)。EGFR突变组的无进展生存期(PFS)和PFS期生存率均高于EGFR未突变组(P<0.05),EGFR突变组中靶向治疗组的无进展生存期(PFS期)和PFS期生存率均高于传统治疗组(P<0.05)。ALK融合基因阳性表达组PFS期生存率低于ALK融合基因阴性表达组(P<0.05),而ROS1和Met的阳性表达与PFS期生存率无关(P>0.05)。结论非小细胞肺癌患者可在治疗前检测驱动基因改变情况,对传统治疗效果及预后的监测具有重要意义。

Objective To explore the relationship between driving genes and clinical pathology, treatment and prognosis in non-small cell lung cancer （NSCLC）. Methods 162 cases of non-small cell lung cancer patients who were treated in changhai hospital from April 2012 to April 2014 were selected for this study. The changes of driving genes epidermal growth factor receptor （EGFR） , anaplastic lymphoma kinase （ALK） , driver genes ROS1 and Met in patients were detected by Taqman-ARMS. The relationship between the driving genes and the general situation （gender, Smoking or Not Smoking） , clinical pathology （TNM and pathological type, differentiation stage ） , treatment and prognosis were analyzed. Results The total mutation rate of EGFR in patients with NSCLC was 34.57%; the total positive rates of ALK and ROS1 fusion genes were 9.88% and 12.35%, respectively; the total amplification rate of Met gene was 6.17%. EGFR mutations were different in patients with smoking or without smoking, differentiation, and TNM staging （P〈0.05）. ALK fusion gene were different in patients with smoking or without smoking and TNM staging （P〈0.05）. The positive expression of Met was different in the differentiation of patients. But the positive expression of ROS 1 fusion gene was not statistically significant in clinical basic data （P〉O.05）. The progression free survival （PFS） and PFS survival rates in the EGFR mutation group were higher than those in the EGFR without mutation group （P〈O.05） , and the survival rates of PFS and PFS in the target group of EGFR mutation group were higher than those in the conventional treatment group （P〈0.05）. The PFS survival rate of the ALK fusion gene positive expression group was lower than that of the ALK fusion negative expression group （P〈0.05）, while the positive expression of ROS 1 and Met was not related to the PFS survival rate （P〉0.05）. Conclusion The changes of driving genes in non-small cell lung cancer could he used for monitoring the effect of traditional treatment and prognosis.