| Objective: To investigate the mutation rate of EGFR gene in NSCLC patients in Qinghai, and the relationship between state of mutation and clinicopathological features.To observe the clinical effect and PFS in NSCLC patients with EGFR mutations after accepting chemotherapy and targeted therapy, so as to provide the NSCLC patients with a strong theoretical basis for the clinical treatment.Methods: To collect NSCLC patients being admitted in hospital of Xining from January 2013 to October 2015, who were confirmed by histopathology derived from biopsy of tissue, lymph node or bronchoscope. The mutation of EGFR was tested by amplification refractory mutation system(ARMS).To record all kinds of patients’ basic information(gender, nationality, age, smoking status), confirmed pathological types, performance status(PS) and staging, so as to analyze the relationship between EGFR status and the factors mentioned above. According to patients’ EGFR status, provide the patients a proper molecular target therapy or chemotherapy, so as to evaluate curative effect of treatment and also to analysis clinical efficiency and PFS.Results: 1、Sensitive EGFR mutations were detected in 27 patients among 70 patients(38.6%).The mutation rate in male and female was 27.3% and 57.7% respectively(p=0.012).Smoking and non-smoking patients mutation rate was 18.5% and 51.2% respectively(p=0.006).Adenocarcinoma and squamous carcinoma mutation rate was 39.7% and 0.00% respectively(p=0.519).The mutation rate in under and over the age of 60 years old was 36.8% and 40.6% respectively(p=0.746).Han and non-han nationality patients mutation rate was 37.3% and 66.7%(p=0.555).The mutation rate in and stage was 33.3% and 45.2%(p=0.313).The mutation rate in Ⅲ ⅣPS with 0-1 scores and 2 sores was 37.9% and 50.0%(p=0.637).EGFR mutations in exon 19 were detected in 15 patients(55.56%,15/27),exon 21 were detected in 11(40.74%,16/27),exon 18 and 20 were detected in 1 at the same time(3.70%,1/27),19 and 21 were detected in 1 at the same time(3.70%,1/27),exon19 and 20 were detected in 1 at the same time(3.70%,1/27).2、The mutation of EGFR gene in NSCLC patients was associated with gender,smoking status, and the difference is statistically significant(P < 0.05);and has no relation with age,pathological type,tumor stage,PS score,ethnic groups,the difference was not statistically significant(P > 0.05).3、The objective response rate(CR+PR) in EGFR positive patients with targeting treatm ent and chemotherapy were 37.5% and 9.1%,indicating no statistically significant diff erence(P > 0.05);thus the clinical benefit response rate(CR+PR+SD) were 87.5% and 27.3%(P<0.05),indicating the difference is statistically significant(P < 0.05). The QRR(CR+PR) was 9.1% in EGFR mutation positive patients with chemotherapy comparedto27.9%innegative group(P>0.05), indicating there was no statistically significant difference(P > 0.05);thus the clinical benefit response rate(CR+PR+SD) were 27.3% compared to 65.1%,indicating the difference is statistically significant(P<0.05).4、The median PFS in TKI therapy group with EGFR mutation positive and chemotherapy group were respectively 240 d and 98d(X2=18.043,P < 0.05). The median PFS in chemotherapy patients with EGFR mutation negative was 201 d.Conclusion: 1、The mutation of EGFR gene in NSCLC patients of Qing hai was 38.6%, being associated with gender and smoking history. The mutatio n rate of EGFR gene in women and nonsmoking patients was higher.2、EGFR mutations give priority to exon 19 and 21.3、The disease control rate in EGFR positive patients with targeting treatment is higher than those patients with ch emotherapy only; in EGFR negative patients with chemotherapy is higher than with targeting treatment.4、NSCLC patients must be tested by EGFR gene bef ore treatment, for TKI treatment gives EGFR positive patients longer PFS than chemotherapy. EGFR positive patients should choose targeting treatment for pr iority; thus EGFR negative patients choose chemotherapy. |
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