Ⅰ~Ⅲ期非小细胞肺癌临床病理特征与淋巴结转移危险因素分析

Analysis of clinicopathological characteristics and risk factors of lymph node metastasis in stage Ⅰ-Ⅲ non-small cell lung cancer

目的探讨非小细胞肺癌(NSCLC)淋巴结转移与临床特征及表皮生长因子受体(EGFR)基因突变的相关性。方法回顾性分析2014-01-02-2019-12-31在山东省肿瘤医院接受肺叶切除和淋巴结清除术的1 112例Ⅰ~Ⅲ期NSCLC患者临床资料。通过单因素和多因素二分类Logistic回归分析确定淋巴结转移的独立危险因素,并比较EGFR基因突变率在淋巴结阳性组与阴性组之间是否存在差异。结果 1 112例NSCLC患者中,478例患者(43.0%)有淋巴结转移。肿瘤大小≥3 cm(OR=2.502,95%CI为1.871~3.346,P<0.001),术前CEA水平≥5 ng/mL(OR=2.246,95%CI为1.659~3.039,P<0.001)及EGFR19del突变(OR=2.340,95%CI为1.104~4.957,P=0.026)是NSCLC患者淋巴结转移的独立危险因素。254例(22.8%)接受EGFR基因测试的患者中,有132例(52.0%)具有敏感的EGFR基因突变,包括56例(42.4%)EGFR19del突变和76例(57.6%)EGFR1858r突变。EGFR19del突变型和野生型淋巴结转移率分别为64.3%(36/56)和55.0%(67/122),χ^(2)=1.381,P=0.240;EGFR突变型和野生型患者淋巴结转移率分别为53.0%(70/132)和54.9%(67/122),χ^(2)=0.091,P=0.763;EGFR19del突变型和EGFRl858r突变型患者淋巴结转移率分别为64.3%(36/56)和44.7%(34/76),差异有统计学意义,χ^(2)=4.947,P=0.026。结论原发肿瘤最大径≥3 cm,术前CEA水平≥5 ng/mL,EGFR19del突变是Ⅰ~Ⅲ期NSCLC发生淋巴结转移的独立危险因素,并且EGFR19del突变比EGFR1858r突变更有可能发生淋巴结转移。

Objective To investigate correlations of clinicopathological features and gene mutations with lymph node metastasis in non-small cell lung cancer(NSCLC).Methods All patients with stageⅠ-ⅢNSCLC who underwent pneumonectomy and lymph node dissection in Shandong Cancer Hospital from January 2,2014to December 31,2019were retrospectively reviewed.Through univariate and multivariate binary logistic regression analysis,the independent risk factors for lymph node metastasis were determined,and the EGFR gene mutation rate was compared whether there was a difference between the lymph node positive group and the negative group.Results Among 1 112NSCLC patients,478patients(43.0%)had lymph node metastasis.Independent risk factors for lymph node metastasis in NSCLC patients included tumor size≥3cm(OR=2.502,95%CI:1.871-3.346,P<0.001),preoperative CEA level≥5ng/ml(OR=2.246,95%CI:1.659-3.039,P<0.001)and EGFR19del mutation(OR=2.340,95%CI:1.104-4.957,P=0.026).Among254patients(22.8%)who underwent EGFRgene testing,132(52.0%)had sensitive EGFRgene mutations,including56(42.4%)EGFR19del mutations and 76(57.6%)EGFR1858rmutations.EGFR19del mutant and wild-type lymph node metastasis rates were 64.3%(36/56)and 55.0%(67/122),respectively,and the difference was not statistically significant(χ^(2)=1.381,P=0.240).Lymph node metastases in EGFR mutant and wild-type were 53.0%(70/132)and 54.9%(67/122),respectively,the difference was not statistically significant(χ^(2)=0.091,P=0.763).Lymph node metastases in EGFR19del mutant and EGFR1858rmutant were 64.3%(36/56)and 44.7%(34/76)respectively,the difference is statistically significant(χ^(2)=4.947,P=0.026).Conclusions The maximum diameter of the primary tumor≥3cm,preoperative CEA level≥5ng/ml,and the EGFR19del mutation were independent risk factors for lymph node metastasis in stageⅠ-Ⅲnon-small cell lung cancer.Moreover,the EGFR19del mutation is more likely to have lymph node metastasis compared to the EGFR1858rmutation.