非小细胞肺癌患者表皮生长因子受体基因突变状态与临床特征及疗效的关系

Mutations of epidermal growth factor receptor gene in non⁃small cell lung cancer patients and the correlation with clinical characteristics and therapeutic effects

目的探讨表皮生长因子受体(EGFR)基因不同突变状态非小细胞肺癌(NSCLC)患者临床特征及疗效的差异。方法回顾性分析2018年4月至2020年6月解放军联勤保障部队第九〇四医院收治的324例NSCLC患者的临床资料,采用基因测序法检测EGFR基因及其第19号和第21号外显子突变情况。将EGFR基因突变患者分为EGFR基因第19号外显子突变组(A组)和EGFR基因第21号外显子突变组(B组),均给予吉非替尼联合TP(紫杉醇+顺铂)方案治疗3个月。比较两组临床特征、疗效及不良反应发生情况。结果234例NSCLC患者中,EGFR基因突变107例(45.73%),其中A组49例,包括delE746‑A750突变32例,delL747‑P753insS 3突变8例,delL747‑A7501突变6例,delL747‑T7511突变3例;B组58例,均为L858R突变。两组均未见第19号和第21号外显子双突变。两组患者性别、TNM分期、病理类型、吸烟史、年龄、分化程度、肿瘤位置、肿瘤长径、淋巴结转移情况比较,差异均无统计学意义(均P>0.05)。A组和B组临床控制率比较[91.8%(45/49)比89.7%(52/58)],差异无统计学意义(χ^(2)=0.15,P=0.699)。两组治疗期间Ⅲ~Ⅳ级不良反应发生率差异均无统计学意义(均P>0.05)。结论NSCLC患者EGFR突变率较高,多表现为EGFR第19号和第21号外显子突变。吉非替尼联合TP方案治疗伴EGFR第19号或第21号外显子突变的NSCLC患者具有较好疗效,且安全性高。

Objective To investigate the clinical characteristics of non‑small cell lung cancer(NSCLC)patients with different epidermal growth factor receptor(EGFR)gene mutations and the comparison of therapeutic effects.Methods The clinical data of 324 patients with NSCLC admitted to the 904th Hospital of the Joint Service Support Force of PLA from April 2018 to June 2020 were retrospectively analyzed.Gene sequencing method was used to detect EGFR gene and mutations of exons 19 and 21.NSCLC patients with EGFR gene mutations were divided into group A(mutation of exon 19 of EGFR gene)and group B(mutation of exon 21 of EGFR gene).Both groups were treated with gefitinib combined with TP(paclitaxel+cisplatin)regimen for 3 months.The clinical features,efficacy and adverse reactions of the two groups were compared.Results Among 234 NSCLC patients,107 cases(45.73%)had EGFR gene mutations.Among them,there were 49 cases in group A(including delE746‑A750 mutation in 32 cases,delL747‑P753insS 3 mutation in 8 cases,delL747‑A7501 mutation in 6 cases,delL747‑T7511 mutation in 3 cases),and there were 58 cases in group B(all L858R mutations),and no double mutations in exons 19 and 21 were found in both groups.There were no significant differences in gender,TNM staging,pathological type,smoking history,age,degree of differentiation,tumor location,tumor diameter,and lymph node metastasis in the two groups(all P>0.05).The difference in the clinical control rates of group A and group B was not statistically significant[91.8%(45/49)vs.89.7%(52/58),χ^(2)=0.15,P=0.699].The incidence of gradeⅢ-Ⅳadverse reactions in the two groups during treatment had no statistically significant differences(all P>0.05).Conclusions EGFR mutation rate in NSCLC patients is relatively high,most of which are EGFR exons 19 and 21 mutations.Gefitinib combined with TP regimen in the treatment of EGFR exons 19 and 21 mutations in NSCLC patients has good curative effects and high safety.