摘要
目的探讨青年肺腺癌患者表皮生长因子受体(EGFR)、KRAS基因突变与临床特点及预后的关系。方法检测168例18~40岁的青年肺腺癌住院患者EGFR与KRAS基因表达情况,并收集其临床资料,分别比较肺腺癌EGFR与KRAS基因突变型与野生型患者的临床特点、治疗及预后的关系。结果 168例青年肺腺癌患者中,检出EGFR基因突变型74例(44.0%),其中19号和21号外显子突变率为90.5%(67/74)。EGFR基因突变型患者中,青年女性与不吸烟患者分别占58.1%、73.0%,高于EGFR基因野生型患者中的37.2%、52.1%(P均<0.01)。EGFR基因突变型患者中,采取EGFR抑制剂(EGFRI)剂治疗的总体缓解率(ORR)、无进展生存期(PFS)均高于采取一线化学治疗的患者(P均<0.05)。检出KRAS基因突变型8例(4.8%),其突变位点均为2号外显子。其中采取一线化学治疗5例、采取EGFRI治疗3例。3例采取EGFRI治疗的KRAS基因突变患者ORR、PFS分别为2/3、(8.4±5.7)个月,一线化学治疗者的ORR、PFS分别为2/5、(6.4±3.6)个月。EGFR基因突变型患者的ORR、PFS均优于野生型患者(P均<0.05),KRAS基因突变型与野生型患者的预后比较差异均无统计学意义(P均>0.05)。结论青年肺腺癌患者的KRAS基因突变率低,EGFR基因突变率高,EGFR基因突变以女性及不吸烟患者居多,EGFR突变型患者行EGFRI治疗可取得良好预后,且EGFR基因突变型患者的预后优于野生型患者。
Objective To investigate the relationship between the epidermal growth factor receptor(EGFR)and KRAS gene mutations and clinical characteristics and prognosis of young and middle-aged patients diagnosed with lung adenocarcinoma.Methods The expression of EGFR and KRAS genes in168lung adenocarcinoma patients aged18to40years was detected and relevant clinical data were collected.Clinical characteristics,therapeutic procedures and clinical prognosis between patients with mutant and wild-type EGFR and KRAS genes were statistically compared.Results Among168lung adenocarcinoma patients,74(44.0%)were determined to have an EGFR mutation,and exon19and21mutation accounted for90.5%(67/74).Among them,the proportion of the young female was58.1%,and73.0%for the non-smokers,significantly higher compared with37.2%and52.1%of their counterparts with wild-type EGFR(both P<0.01).The overall response rate(ORR)and progression-free survival(PFS)of EGFR mutation patients treated with EGFR inhibitor(EGFRI)were significantly higher than those of their counterparts receiving the firstline chemotherapy(both P<0.05).Eight patients(4.8%)were detected to have KRAS mutation at exon2.Five cases received the first-line chemotherapy,and3treated with EGFRI.The ORR and PFS of5patients receiving EGFRJtherapy were2/3and(8.4±5.7)months,and2/5and(6.4±3.6)months for their counterparts treated with the first-line chemotherapy.The ORR and PFS of EGFR mutant patients were significantly higher than those with wild-type EGFR(both P<0.05).No statistical significance was identified in terms of the prognosis between patients with mutant and wild-type KRAS(both P>0.05).Conclusions Young and middle-aged lung adenocarcinoma patients have a low risk of KRAS mutation,whereas a high risk of EGFR mutation.A majority of EGFR mutation patients are the female and non-smokers.EGFR mutant patients can obtain favorable clinical prognosis after EGFRI therapy.The clinical prognosis of EGFR mutant patients is better than that of those with wild-type EGFR.
作者
朱晓丹
陈成水
Zhu Xiaodan;Chen Chengshui(Department of Respiratory, Yiwu Hospital Affliated to Wenzhou Medical University, Yiwu 322000, China)
出处
《新医学》
2017年第7期495-498,共4页
Journal of New Medicine
关键词
肺腺癌
表皮生长因子受体
KRAS
基因检测
预后
Lung adenocarcinoma
Epidermal growth factor receptor
KRAS
Gene detection
Prognosis
