Peripheral Blood And Tissue EGFR Gene Detection And Clinical Efficacy Analysis Of Gefitinib In Patients With Lung Adenocarcinoma In Qinghai Region

Objective: To observe the relationship between clinical and imaging features,tumor markers and EGFR gene mutation in peripheral blood of patients with lung adenocarcinoma in Qinghai;to observe the effect of EGFR gene mutation site in peripheral blood on gefitinib treatment effect;and to observe the consistency of EGFR gene detection between tissue and peripheral blood.Methods: From September 2017 to October 2018,the patients who were diagnosed pathologically as lung adenocarcinoma in Qinghai University affiliated Hospital and Qinghai Provincial people’s Hospital were examined for EGFR gene in peripheral blood and analyzed their clinical characteristics(sex,age,nationality,smoking,transfer site,etc.);Follow-up of patients with different mutation sites of EGFR showed whether there was difference in PFS after oral administration of gefitinib.We examined the tissue and blood samples of patients who could provide sufficient samples(surgical or puncture specimens)at the same time to explore the consistency of EGFR gene mutation detection between the two groups.Results: 1.A total of 156 patients with lung adenocarcinoma who underwent peripheral blood EGFR gene detection were collected,and 82 of them had gene mutation,accounting for 52.6%.The mutation rates of male and female were 16.0% and 36.5%,respectively.The difference was statistically significant(P < 0.05).There were 45 cases of smoking,111 cases of non-smoking,18 cases of mutation,the mutation rate was 40.0%,64 cases of non-smoking patients,mutation rate was 57.7%,the gene mutation rate of non-smoking patients was higher than that of smoking patients,The difference was statistically significant(P < 0.05).The mutation rate of III~IV patients was higher than that of control group(P < 0 05).There was no correlation between age and nationality of EGFR gene mutation in peripheral blood.2.EGFR gene mutation was not associated with tumor size,lung metastasis,liver metastasis,adrenal metastasis and distant lymph node metastasis.The mutation rate in patients with malignant serous effusion、bone metastasis and brain metastasis were72.4%,25.8% and 44.0%,respectively,which was significantly higher than that in patients without metastasis(P < 0.05).3.The frequency of EGFR gene mutation in peripheral blood of CT patients with ground glass shadow or cavity and vacuole was higher than that of control group(P < 0 05),and there was a significant difference between the two groups(P < 0 05).However,EGFR gene mutation was not associated with prickle sign,lobulation,vascular aggregation sign,bronchus sign and pleural depression.4.There was a higher mutation rate of EGFR gene in the patients with increased CA125,and there was a significant difference between the two groups(P = 0.003).5.Multivariate analysis showed that female,bone metastasis,grinding glass shadow,cavity vacuole and malignant serous effusion were independent predictors of EGFR gene mutation in peripheral blood.6.There were 82 cases of EGFR mutation in peripheral blood,including 11 cases,36 cases,25 cases,5 cases,2 cases and 3 cases of 18,19,21 site mutation,combined mutation,20 insertion mutation and T790 M mutation.Follow-up of 18,19,21 and combined mutations showed that there were differences in oral TKI,PFS among patients with different mutation sites and longer PFS in patients with 19 mutations(P < 0.05).7.The mutation rate of peripheral blood was 56.9%,and tissue gene was 68.8%,The consistency of peripheral blood and tissue test was good(kappa = 0.504).The difference was statistically significant(P < 0.05),and the mutation rate of tissue was higher than that of peripheral blood.Conclusion: 1.Gender,non-smokers,patients with bone metastasis or brain metastasis or malignant serous effusion,patients with vacuoles or ground glass opacity on CT,and patients with elevated CA125 tumor marker were more likely to have EGFR gene mutations.Multivariate analysis showed that women,bone metastasis,ground glass opacity,vacuoles and malignant serous effusion were independent predictors of EGFR gene mutation in peripheral blood.2.The PFS of patients with different mutation sites were significantly different.The patients with 19 deletion mutations had longer PFS. 3.The detection of EGFR mutation gene in peripheral blood has good consistency with that in tissues and has clinical application value.