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云南省肺癌患者表皮生长因子受体基因突变的临床特征分析

Analysis of EGFR mutation and clinical features of lung cancer in Yunnan

摘要:

目的:探讨云南省肺癌患者表皮生长因子受体(EGFR)突变特征,为云南省肺癌的临床个体化靶向治疗提供依据。方法:收集云南省肿瘤医院2014年1月至2019年8月2 967例行EGFR基因检测肺癌患者的人口学资料和临床资料,分析EGFR突变情况。结果:2 967例肺癌患者的EGFR突变率为46.2%(1 370/2 967)。单因素分析显示,女性突变率高于男性( P<0.001);随年龄增长,突变率呈下降趋势( P=0.030);少数民族突变率高于汉族( P=0.012);无吸烟史患者突变率高于吸烟史患者( P<0.001);无饮酒史患者突变率高于饮酒史患者( P<0.001);无肺癌家族史患者突变率高于肺癌家族史患者( P=0.008);腺癌突变率高于鳞癌、腺鳞癌、小细胞癌及其他病理类型( P<0.001);早期患者突变率高于晚期患者( P<0.001);组织标本检测突变率高于细胞学检测和外周血检测( P<0.001);宣威地区突变率低于非宣威地区患者( P<0.001)。logistic多因素分析显示,仅性别( P<0.001)、年龄( P=0.036)、吸烟史( P<0.001)、病理类型( P<0.001)、标本类型( P<0.001)和是否宣威地区( P<0.001)是EGFR基因突变的独立影响因素,女性、不吸烟、腺癌、非宣威地区、病理组织标本、年轻肺癌患者更易发生EGFR基因突变。1 370例EGFR突变患者的主要突变类型为19-Del和L858R,占38.2%。宣威地区G719X、G719X+L861Q、G719X+S768I和S768I的突变率高于非宣威地区( P<0.05);而19-Del、L858R、20-ins的突变率低于非宣威地区( P<0.05)。少数民族19-Del的突变率高于汉族( P<0.001);汉族G719X+L861Q的复合突变率高于少数民族( P=0.005)。 结论:云南省肺癌患者EGFR突变率与亚洲和中国整体人群突变率相近,女性、不吸烟、腺癌、年轻患者EGFR突变率较高,宣威地区患者突变率较低。最常见的EGFR突变类型为19-Del和L858R,宣威地区以L858R突变为主,非宣威地区以19-Del为主。云南省肺癌患者稀有突变(G719X、G719X+L861Q、G719X+S768I、S768I)的突变率较高,宣威地区稀有突变率高于非宣威地区,汉族G719X+L861Q的复合突变率高于少数民族。

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abstracts:

Objective:To analyze the EGFR mutation profile of lung cancer patients in Yunnan, and to provide evidence for clinical personalized treatment.Methods:Demographic and clinical data of 2 967 lung cancer patients undergoing EGFR identification were collected and analyzed from January 2014 to August 2019 in Yunnan Cancer Hospital.Results:The proportion of EGFR mutation in 2 967 patients with lung cancer was 46.2%. Univariate analysis showed that the proportion of EGFR mutation in women was higher than that in men ( P<0.001) and displayed a downward trend with age ( P=0.03). The mutation rate of ethnic minorities was higher than Han ( P=0.012). Mutation rate in patients without smoking history was higher than those with smoking history ( P<0.001), and patients without drinking history was higher than patients with drinking history ( P<0.001). Mutation rate in patients without family history of lung cancer was higher than those with family history ( P=0.008). The mutation rate of adenocarcinoma was higher than other pathological types ( P<0.001). The mutation rate was different among stages, and it was higher in early patients than that in advanced patients ( P<0.001). The mutation rate of tissue specimens was higher than those of cytology and peripheral blood samples ( P<0.001). The mutation rate of Xuanwei area was lower than that in non-Xuanwei area ( P<0.001). Multivariate analysis showed that gender ( P<0.001), age ( P=0.036), smoking history ( P<0.001), pathological type ( P<0.001), specimen type ( P<0.001), and whether or not Xuanwei area ( P<0.001) were the independent factors of EGFR mutation.The EGFR mutation was more common in female, non-smokers, adenocarcinoma, non-Xuanwei area, tissue specimen and young lung cancer patients.The mutation types of EGFR in 1 370 cases mainly included 19-Del and L858R. The predominant mutation of EGFR in Xuanwei area was L858R, while in non-Xuanwei area was 19-Del.The mutation rates of G719X, G719X+ L861Q, G719X+ S768I, and S768I in Xuanwei were higher while the mutation rates of 19-Del, L858R, and 20-ins were lower than non-Xuanwei area ( P<0.05). The 19-Del mutation rate of ethnic minorities is higher than that of Han ( P<0.001). The combined mutation rate of G719X, L861Q in Han was higher than that of ethnic minorities ( P=0.005). Conclusions:The EGFR mutation rate in lung cancer patients in Yunnan is similar to Asian and Chinese, and higher in female, non-smokers, adenocarcinomas, young and non-Xuanwei area patients. The most common types of EGFR mutation in Yunnan are 19-Del and L858R. The predominant mutation of EGFR in Xuanwei area is L858R, while in non-Xuanwei area is 19-Del. The mutation rates of G719X, G719X+ L861Q, G719X+ S768I and S768I are higher in Xuanwei patients than those in non-Xuanwei patients. The combined mutation rate of G719X and L861Q in Han nationality is higher than that of ethnic minorities.

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期刊: 《中华肿瘤杂志》2020年42卷9期 729-734页 MEDLINEISTICPKUCSCDCABP
栏目名称: 临床研究
DOI: 10.3760/cma.j.cn112152-20200313-00201
发布时间: 2020-09-28
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