不同EGFR基因状态肺癌患者p53、COX-2表达及其临床意义

Expression Characteristics and Clinical Value of p53 and COX-2 in Lung Cancer Patients with Different EGFR Gene Status

【目的】探讨P53蛋白、环氧化酶-2(COX-2)在不同表皮生长因子受体(EGFR)基因状态肺癌患者中的表达特征,并分析其临床意义。【方法】回顾性分析本院2017年4月至2018年4月收治的96例肺癌患者的临床资料,所有患者均经穿刺活检病理学确诊。经Taqman-ARMS法测定EGFR基因是否发生突变,并据此分成突变组、野生型组。经免疫组化法测定p53、COX-2蛋白在肺癌组织中的表达情况,比较突变组、野生型组的p53、COX-2表达情况。随访12个月,分析患者随访期间的生存、死亡情况。比较不同基因状态患者p53、COX-2表达与生存、死亡的关系,采用Logistic回归模型分析肺癌患者预后不良的危险因素。【结果】经检测提示EGFR突变42(43.75%)例,野生型54(56.25%)例。突变组的p53、COX-2阳性表达率分别为33.33%、40.48%,显著低于野生型组的57.41%、61.11%(P<0.05)。在随访期间,有29(30.21%)例死亡,67(69.79%)例生存。p53阳性患者生存率为53.33%,显著低于p53阴性患者的84.31%,其病死率也显著高于p53阴性患者(46.67%vs15.69%,P<0.05)。COX-2阳性患者生存率为56.00%,显著低于COX-2阴性患者84.78%,其病死率也显著高于COX-2阴性患者(44.00%vs5.22%,P<0.05)。Logistic回归性分析提示分化程度(中/低分化)、肿瘤分期(Ⅲ~Ⅳ)、淋巴结转移、肿瘤直径≥3cm、p53阳性、COX-2阳性是肺癌患者预后不良的危险因素(P<0.05)。【结论】EGFR基因突变的肺癌患者p53、COX-2阳性率较低,且p53、COX-2阳性患者的死亡风险更高,二者均是肺癌预后不良的危险因素。

【Objective】To investigate the expression of P53 protein and cyclooxygenase-2(COX-2)in lung cancer patients with different epidermal growth factor receptor(EGFR)gene status,and analyze their clinical value.【Methods】The clinical data of 96 patients with lung cancer admitted to our hospital from April 2017 to April 2018 were retrospectively analyzed.All patients were confirmed by pathological puncture.The mutation of EGFR gene was detected by Taqman-ARMS method.According to the results of EGFR mutation,patients were further divided into the mutant group and the wild type group.The expression of p53 and COX-2 in lung cancer tissues was determined by immunohistochemical method.Then the expression of p53 and COX-2 in the mutant group and the wild type group was compared.The patients were followed up for 12 months.Survival and death were analyzed.The survival and death of patients with different expression of p53 and COX-2 were compared as well.The risk factors of poor prognosis of lung cancer patients were analyzed by logistic regression model.【Results】The mutation detection showed that there were 42(43.75%)cases of the EGFR mutation and 54(56.25%)cases of wild type EGFR.The positive expression rates of p53 and COX-2 in the EGFR mutant group were 33.33%and 40.48%respectively,which were significantly lower than those in wild type EGFR group(57.41%and 61.11%,respectively,)(P<0.05).During the follow-up period of all 96 patients,29(30.21%)died and 67(69.79%)survived.Of which,the survival rate of p53 positive patients was 53.33%,significantly lower than that of p53 negative patients(84.31%);and the mortality rate of p53 positive patients was 46.67%,which was significantly higher than that of p53 negative patients(15.69%)(P<0.05).The survival rate of COX-2 positive patients was 56.00%,which was significantly lower than that of COX-2 negative patients(84.78%).The death rate of COX-2 positive patients was 44.00%,which was significantly higher than that of COX-2 negative patients(15.22%)(P<0.05).Logistic regression analysis showed that the degree of differentiation(moderate to low differentiation),stage of tumors(Ⅲ-Ⅳ),lymph node metastasis,diameter of tumors(>3cm),p53 positive and COX-2 positive expression were risk factors for poor prognosis in patients with lung cancer(P<0.05).【Conclusion】The positive rates of p53 and COX-2 in lung cancer patients with EGFR gene mutation were lower,and the mortality risk of p53 and COX-2 positive patients was higher.Both of them were risk factors for poor prognosis of lung cancer.