EGFR基因不同位点突变对于多原发肺癌的诊断与鉴别诊断价值

Value of EGFR gene mutations for diagnosis and differential diagnosis of multiple primary lung cancer

目的通过回顾性分析多原发肺癌与肺癌肺内转移患者的临床资料,探讨EGFR基因不同位点突变对于鉴别多原发肺癌与肺癌肺内转移的临床价值。方法通过查询电子病历系统收集2020年1月至2021年10月在郑州大学第一附属医院确诊的多原发肺癌(≥2个病灶)与肺癌肺内转移的病例,统计并记录患者的性别、年龄、肿瘤的大小、数目、分布位置、病理类型、TNM分期及EGFR基因突变情况等临床信息,采用SPSS 21.0进行统计学分析,组间比较采用卡方检验,以P<0.05为差异有统计学意义。结果共收集多原发肺癌患者76例,肺内转移患者38例。在多原发肺癌患者中,女性49例(64.5%),男性27例(35.5%),双原发肺癌63例(82.9%),3个或3个以上病灶的多原发肺癌患者13例(17.1%),肿瘤位于异侧的有38例(50.0%),同侧38例(50.0%),共计174个肿瘤灶,其中2个(2.6%)肿瘤灶病理类型为鳞癌,其余172个(97.4%)肿瘤灶均为腺癌。在76例多原发肺癌患者中,有61例(80.3%)患者进行了基因检测,其中EGFR21 p.L858R突变患者27例(44.3%),EGFR 19外显子缺失患者11例(18.0%);而在38例肺癌肺内转移患者中携带EGFR21 p.L858R突变的患者有8例(21.1%),携带EGFR 19外显子缺失的患者有30例(78.9%)。卡方检验结果显示,EGFR 21 p.L858R突变(P=0.019)和EGFR 19外显子缺失突变(P=0.036)在两组间差异有统计学意义。结论病理类型为腺癌的多原发肺癌患者,更容易出现EGFR 21 p.L858R基因突变。而肺腺癌并肺内转移的患者更容易出现EGFR 19外显子缺失突变。这提示EGFR21 p.L858R基因突变可作为多原发肺癌与肺内转移的鉴别要点。

Objective To investigate the clinical value of EGFR gene mutation through the purpose of retrospectively analyzing the clinical data of multiple primary lung cancer and lung cancer.Methods Collect the cases diagnosed from January 2020(2 lesions)and lung metastasis of lung cancer from January 2020 to October 2021,record sex,age,tumor size,number,distribution,pathological type,EGFR mutation and TNM by SPSS 21.0 and chi-square test for P<0.05.Results A total of 76 patients with multiple primary lung cancer and 38 patients with internal lung metastasis were collected.Among multiple primary lung cancer,49 women(64.5%),27 males(35.5%),63 double primary lung cancer(82.9%),3 or more lesions,13(17.1%),38(50.0%),38(50.0%),a total of 174,2(2.6%)were squamous carcinoma,and the remaining 172(97.4%)were adenocarcinoma.Of the 76 patients with multiple primary lung cancer,61(80.3%)were genetically tested,including 27 with EGFR21 p.L858R mutation(484.3%)and 11(18.0%);8(21.58%)and 30 with exon deletion(78.9%).The results of the chi-square test showed that the EGFR 21 p.L858R mutation(P=0.019)and the EGFR 19 exon deletion mutation(P=0.036)varied between the two groups.Conclusion Patients with multiple primary lung cancer with pathological type adenocarcinoma are more likely to develop EGFR 21 p.L858R gene mutation.However,patients with lung adenocarcinoma and internal lung metastases are more likely to develop EGFR 19 exon deletion mutations.This suggests that mutation in EGFR21 p.L858R gene can be used as a differentiation of multiple primary lung cancer from lung metastasis.