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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (02) : 164 -168. doi: 10.3877/cma.j.issn.1674-6902.2020.02.008

论著

非小细胞肺癌E19-Del、L858R突变临床特征分析
房延凤1, 马李杰2, 刘雁声1, 南岩东1, 苏蔚1, 金发光1, 张涛1, 张红军1,†()   
  1. 1. 710038　西安，空军（第四）军医大学第二附属医院呼吸与危重症医学科
    2. 610083　成都，西部战区总医院呼吸与危重症医学科
  • 收稿日期:2019-06-11 出版日期:2020-04-25
  • 通信作者: 张红军
  • 基金资助:
    国家公益性行业科研专项(201402024); 唐都医院科技创新发展基金(2017LCYJ016)

Clinical features of E19-Del and L858R gene mutations in patients with non-small cell lung cancer

Yanfeng Fang1, Lijie Ma2, Yansheng Liu1, Yandong Nan1, Wei Su1, Faguang Jin1, Tao Zhang1, Hongjun Zhang1,†()   

  1. 1. Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Air Force Military Medical University, Xi′an 710038, China
    2. Department of Pulmonary and Critical Care Medicine, General Hospital of Western Theater Command, Chengdu 610083, China
  • Received:2019-06-11 Published:2020-04-25
  • Corresponding author: Hongjun Zhang
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房延凤, 马李杰, 刘雁声, 南岩东, 苏蔚, 金发光, 张涛, 张红军. 非小细胞肺癌E19-Del、L858R突变临床特征分析[J]. 中华肺部疾病杂志(电子版), 2020, 13(02): 164-168.

Yanfeng Fang, Lijie Ma, Yansheng Liu, Yandong Nan, Wei Su, Faguang Jin, Tao Zhang, Hongjun Zhang. Clinical features of E19-Del and L858R gene mutations in patients with non-small cell lung cancer[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(02): 164-168.

目的

探讨非小细胞肺癌E19-Del、L858R突变临床特征。

方法

纳入2012年7月至2018年7月在空军军医大学第二附属医院呼吸与危重症医学科基因检测中心行EGFR基因检测的498例非小细胞肺癌肺癌患者，回顾性分析其E19-Del、L858R突变临床特征及相互间突变的差异。

结果

E19-Del在小于50岁、大于等于70岁、大于等于50岁而小于70岁时突变率逐渐降低(χ2＝5.984，P＝0.050)，不吸烟组E19-Del突变率高于吸烟每天大于20支组(χ2＝4.328，P＝0.037)，E19-Del在腺癌组、鳞癌组、其他类型非小细胞肺癌组突变率逐渐降低(χ2＝12.197，P＝0.000)，E19-Del在Ⅳ期、Ⅲ期、Ⅰ+Ⅱ期突变率逐渐降低(χ2＝6.625，P＝0.036)，以上均有统计学差异；L858R女性突变率高于男性(χ2＝13.755，P＝0.000)，L858R在不吸烟组、吸烟每天小于或等于20支组、吸烟每天大于20支组突变率逐渐降低(χ2＝7.234，P＝0.027)，L858R在腺癌组、其他类型非小细胞肺癌组突变率逐渐降低(χ2＝5.538，P＝0.021)，胸膜转移组L858R突变率高于未发生胸膜转移组(χ2＝4.004，P＝0.045)，以上均有统计学差异。

结论

E19-Del在年轻非吸烟Ⅳ腺癌组突变率高；L858R在女性非吸烟腺癌并胸膜转移组突变率高；E19-Del、L858R在肿瘤发生部位，有无并发糖尿病、高血压、其它肿瘤或是否存在骨转移、头颅转移、淋巴结转移时突变率各有差异，但均无统计学差异。

关键词: 非小细胞肺癌, E19-Del, L858R, 临床特征
Objective

To study the clinical characteristics of patients of non-small cell lung cancer (NSCLC) who had E19-Del and L852R gene mutation.

Methods

This study summarized total 498 patients of NSCLC who received gene tests in respiratory and critical care medicine department in Tangdu hospital, The Fourth Military Medical University from Jul. 2012 to Jul. 2018. The correlations between the E19-Del and L852R gene mutation and the clinical characteristics of the patients were retrospective analyzed.

Results

E19-Del gene mutation rate was declining in the following groups: the age less than 50 years, the age more than 70 years and the age between 50 years and 70 years (χ2=5.984, P=0.050). Non-smokers had higher E19-Del gene mutation rate than patients who smoke more than 20 cigarettes a day (χ2=4.328, P=0.037). E19-Del gene mutation rate also declined in the following groups: adenocarcinoma and other types of NSCLC (χ2=12.197, P=0.000). And E19-Del gene mutation rate was declining as the reducing of pathological stage (χ2=6.625, P=0.036). L858R gene mutation rate of female was higher than male (χ2=13.755, P=0.000). As the lessening of patients smoking degree, L858R gene mutation rate was declining (χ2=7.234, P=0.027). L858R gene mutation rate also declined in the following groups: adenocarcinoma and other types of NSCLC (χ2=5.538, P=0.021). L858R gene mutation of patients who had pleura metastasis was higher than who did not (χ2=4.004, P=0.045).

Conclusion

There is some significant difference of clinical features in E19-Del gene mutation with non-smoking and young people in NSCLC. Then L858R gene mutation rate was high in non-smoking women and patients who had pleura metastasis. Both E19-Del and L858R gene mutation rate had no significant correlations with whether patients had different tumor position, diabetes, high blood pressure, bone metastasis, cranium metastasis and lymphomatous metastasis.

Key words: non-small cell lung cancer, E19-Del, R858L, clinical characteristics
表1 E19-Del突变率与临床分层特征
临床资料 未突变人数(n) 突变人数(n) 突变率(%) χ2值 P值
年龄(岁)          
  age<50 56 15 21.127 5.984 0.050
  50<＝age<70 274 32 10.458    
  age>＝70 105 16 13.223    
病理分型          
  LUAD 345 62 15.233 12.197 0.000
  others 90 1 1.099    
性别          
  male 272 33 10.820 2.388 0.122
  female 163 30 15.544    
部位          
  right 246 34 12.143 0.149 0.699
  left 189 29 13.303    
并发其它肿瘤          
  no 428 63 12.831   0.604
  yes 7 0 0    
胸膜转移          
  no 271 41 13.141 0.182 0.670
  yes 164 22 11.828    
骨转移          
  no 320 39 10.864 3.717 0.054
  yes 115 24 17.267    
脑转移          
  no 390 54 12.162 0.884 0.337
  yes 45 9 16.667    
淋巴结转移          
  no 186 31 14.286 0.930 0.335
  yes 249 32 11.388    
并发糖尿病          
  no 401 59 12.826 0.168 0.682
  yes 34 4 10.526    
并发高血压          
  no 339 52 13.299 0.693 0.405
  yes 96 11 10.280    
分期          
  Ⅰ 12 1 7.692 4.430 0.114
  Ⅲ 74 5 6.329    
  Ⅳ 332 57 14.653    
  Ⅲ 74 5 6.329 3.959 0.047
  Ⅳ 332 57 14.653    
  Ⅰ 12 1 7.692   0.433
  Ⅱ 17 0 0    
  Ⅰ+Ⅱ 29 1 3.333 6.625 0.036
  Ⅲ 74 5 6.329    
  Ⅳ 332 57 14.653    
表2 E19-Del突变与吸烟量分层特征
吸　烟E19-Del 未突变人数(n) 突变人数(n) 突变率(%) χ2值 P值
non-smoker 222 37 14.286 4.347 0.114
≤20 per day 142 22 13.415    
>20 per day 71 4 5.333    
non-smoker 222 37 14.286 4.328 0.037
>20 per day 71 4 5.333    
non-smoker 222 37 14.286 0.063 0.801
≤20 per day 142 22 13.415    
≤20 per day 142 22 13.415 3.467 0.063
>20 per day 71 4 5.333    
表3 L858R突变率与临床分层特征
临床资料 未突变人数(n) 突变人数(n) 突变率(%) χ2值 P值
年龄(岁)          
  age<50 65 6 8.450 0.161 0.923
  50<＝ age<70 279 27 8.824    
  age>＝70 109 12 9.917    
吸烟          
  non-smoker 227 32 12.355 7.234 0.027
  ≤20 per day 155 9 5.488    
  >20 per day 71 4 5.333    
病理分型          
  LUAD 364 43 10.565 6.393 0.041
  others 89 2 2.198    
性别          
  male 289 16 5.246 13.755 0.000
  female 164 29 15.026    
部位          
  right 252 28 10.000 0.723 0.395
  left 201 17 7.798    
并发其它肿瘤          
  no 447 44 8.961 0.238 0.626
  yes 6 1 14.286    
胸膜转移          
  no 290 22 7.051 4.004 0.045
  yes 163 23 12.366    
骨转移          
  no 328 31 8.635 0.252 0.616
  yes 125 14 10.072    
脑转移          
  no 402 42 9.459 0.893 0.345
  yes 51 3 5.556    
淋巴结转移          
  no 203 14 6.452 3.125 0.077
  yes 250 31 11.032    
并发糖尿病          
  no 416 44 9.565 2.053 1.052
  yes 37 1 2.632    
并发高血压          
  no 352 39 9.974 1.949 0.163
  yes 101 6 5.607    
分期          
  Ⅰ 12 1 7.692 3.284 0.350
  Ⅱ 15 2 11.765    
  Ⅲ 76 3 3.797    
  Ⅳ 350 39 10.026    
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