表皮生长因子受体在肺癌组织的表达及临床意义

Expression and clinical significance of epidermal growth factor receptor in lung cancer tissues

目的探讨肺癌人群表皮生长因子受体（EGFR）突变状态及临床病理特征。方法收集246例非小细胞肺癌标本，采用扩增阻滞突变系统（ARMS）法检测EGFR基因突变状态。手术标本的组织学亚型依据2016年世界卫生组织（WHO）分类和2011年最新国际肺癌研究学会（IASLC）、美国胸科学会（ATS）和欧洲呼吸学会（ERS）分类方法进行分类。分析肺癌亚型与EGFR突变状态和临床病理特征之间的关系。结果246例患者中EGFR的突变率为38.6％（95／246），以EGFR19外显子E746A750点突变（60.0％）和21外显子L858R点突变（34.7％）为主，其中女性（49.1％）、不吸烟患者（48.1％）、腺癌（44.3％）具有更高的突变率，差异有统计学意义。对例大体肺叶切除肺腺癌的组织学亚型分析发现，EGFR突变主要集中于贴壁型（67.9％）、腺泡型腺癌（53.8％），而实性型腺癌（16.7％）、黏液腺癌（21.4％）则罕见。结论本组肺癌研究中EGFR突变率及类型与亚洲流行率一致，EGFR突变状态与性别，吸烟状态及组织学亚型明显相关，女性，非吸烟，贴壁型、腺泡型腺癌有助于预测高EGFR突变率，而实性型、黏液腺癌突变率低。

Objective To investigate the mutation status and clinicopathological features of epidermal growth factor receptor （EGFR） in lung cancer. Methods 246 non-small cell lung cancer specimens were collected and the mutation status of EGFR gene was detected by amplification refractory mutation system （ARMS）. The histological subtypes of surgical specimens were classified according to world health organization （WHO） classification in 2016 and association for the study of lung cancer （IASLC）/american thoracic society （ATS）/european respiratory society （ERS） classification in 2011. SPSS 22.0 statistical software was used to analyze the relationship between lung cancer subtypes, EGFR mutation status and clinicopathological features. Results The mutation rate of EGFR was 38.6% （95/246） in 246 patients. The mutation rate of EGFR19 exon E746 A 750 （60.0% ） and exon 21 L858R （34.7% ） were the main mutations. The mutation rates of female （49.1% ）, non-smoking （48.1% ） and adenocarcinoma （44.3%） were higher than those of normal controls. Histological subtypes of lung adenocarcinoma after lobectomy showed that EGFR mutations were mainly concentrated in adhering adenocarcinoma （67.9% ） and acinar adenocarcinoma （53.8%）, while solid adenocarcinoma （16.7%） and mucinous adenocarcinoma （21.4%） were rare. Conclusion The mutation rate and type of EGFR in the lung cancer study are consistent are consistent with the prevalence rate in Asia. The mutation status of EGFR is significantly correlated with sex, smoking status and histological subtypes. Women, non-smoking, adherent adenocarcinoma and acinar adenocarcinoma are helpful in predicting the high mutation rate of EGFR, while the mutation rate of solid adenocarcinoma and mucinous adenocarcinoma is low.