Diagnosis And Treatment Of 128 Cases Of Advanced Metastatic Non-small Cell Lung Cancer

Objective: To investigate the diagnosis and treatment of non-small cell lung cancer(NSCLC)and the relationship between gene status,therapeutic effect and prognosis.Methods: 128 patients with advanced metastatic NSCLC were admitted to the Fourth Hospital of Hebei Medical University from 2014 to 2018.EGFR gene was detected in 91 patients with serous effusion or plasma.Survival analysis was performed on patients' general characteristics,genetic status and first-line treatment.The therapeutic effect was analyzed according to gene status and first-line treatment status.Chi-square test and T-test were used to analyze the relationship between different genes and signal transduction pathways.Analysis by SPSS statistical software v.23.0.Result: 1 Clinical data of patientsIn terms of gender,the male to female ratio of 128 patients was 1.33:1.Age,from 29 to 82 years old,the median onset time is 61 years old,61-65 years old is a high incidence age.Pathological type,103 cases of adenocarcinoma,accounting for 80.5%,25 cases of squamous cell carcinoma,accounting for 19.5%.The primary tumor site,55 cases of left lung,accounting for 43%,73 cases of right lung,accounting for 57%,the right lung was higher than the left lung.91 patients underwent EGFR detection,the proportion of detection was 71.1%,including 61 cases(67.0%)in tissue examination,14 cases(15.4%)in serous effusion,and 16 cases(17.6%)in plasma.There were 42 cases of EGFR mutation,and the mutation accounted for 32.8%,including 1 case(2.4%)of E18 mutation,13 cases(31.0%)of E19 mutation,3 cases(7.1%)of E20 mutation,and 22 cases(52.4%)of E21 mutation.Multiple target mutations in 3 cases(7.1%).2 Analysis of the relationship between clinical factors and survival2.1 Survival relationship analysis of general characteristics of patientsThere were no statistically significant differences in gender,age,and location between PFS and OS.Staging was statistically significant for OS,P = 0.000,and the earlier the stage,the better the prognosis.PFS was superior to squamous cell carcinoma in patients with adenocarcinoma.The median PFS was 5.5 months vs 2.5 months.The difference was statistically significant(P=0.022).However,the median OS of patients with adenocarcinoma and squamous cell carcinoma was 9.0 months vs.5.0 months.The difference was not statistically significant,P = 0.052.2.2 Survival analysis of EGFR status detected by different specimensThe mutation rate of tissue detection was 47.5%.The PFS and OS of the mutation group were better than those of the non-mutation group.The average PFS was 10.12 months vs.6.13 months,P=0.035,and the average OS was 26.70 months vs.9.89 months,P=0.009.,The difference was statistically significant.The mutation rate of serous effusion was 64.3%.There was no significant difference between PFS and OS in the mutation group and the unmutated group.The average PFS was 9.44 months vs 6.6 months,the P value was 0.220,and the average OS was 26.72 months.At 11.3 months,the P value was 0.658.The mutation rate of plasma test was 25.0%.There was no significant difference in PFS and OS between the mutant group and the unmutated group.The average PFS was 12.36 months vs.8.58 months,P=0.773,and the average OS was 22.04 months vs.18.86 months.P =0.751.2.3 Analysis of survival relationship between EGFR status and first-line treatmentIn patients with first-line chemotherapy,patients with EGFR mutations were better than those without mutations.mPFS was 6 months vs 5 months,OS was 13 months vs 43 months,but there was no statistical difference between them,P was 0.894.,0.050.After the grouping of the mutation sites,the EGFR E19 deletion mutation was significantly different from the EGFRnegative patient OS.The OS was 92 months versus 13 months,and the P value was 0.024.It is suggested that the prognosis of first-line chemotherapy in patients with EGFR E19 mutation may be better than that in patients without EGFR mutation.First-line targeted therapy for PFS was superior to first-line chemotherapy in patients with EGFR mutations.The mPFS was 8.5 months versus 6 months,and the difference was statistically significant(P=0.027).The OS of the two was 20.5 months vs.43 months,and P=0.567 was not statistically different.It is suggested that the first-line targeted prognosis of EGFR-positive patients is better than first-line chemotherapy..2.4 EGFR Status,First-line Therapy and Therapeutic EffectFor the first-line chemotherapy patients,there was no significant difference between the EGFR positive group and the negative group in 2 and 4 cycles,P was 0.652 and 0.888,respectively.For EGFR positive patients,there was no significant difference in the efficacy between the first-line chemotherapy group and the target group,P values were 0.654 and 0.382,respectively.Analysis of the data shows that there is no significant difference in the effect of EGFR status.3 Real-world analysis of gene mutation in NSCLC patients 3.1 Distribution of Mutant Genes in Lung Cancer SamplesTP53,EGFR and FBXW7 were the main high-frequency genes detected in lung cancer by polygene panel sequencing.In addition,CDH1,KIT,APC,ARID1 A and other driving genes appeared more frequently in lung cancer.TP53,EGFR and KIT had the highest mutation abundance,while BRCA1,ARID1 A and FBXW7 had the lowest mutation abundance.3.2 Analysis of signal pathways related to mutant genes in lung cancer samplesThe mutation genes with frequency(> 3 times)were listed and their related gene pathways were analyzed.In addition to TP53,RTK/RAS,PI3 K and cell cycle signaling pathways that have been reported to be significantly related to lung cancer,DNA mismatch repair and Wnt signaling pathways,chromosome modification,epigenetic modification and hormone signaling pathways have also been found in lung cancer.The relationship between WNT signaling pathway and EGFR mutation was analyzed.For patients with positive or negative EGFR mutation,the mutation frequency of WNT signaling pathway had potential difference trend,but there was no statistical difference,P=0.300.3.3 Types of EGFR Mutation in Lung Cancer SamplesEGFR mutation or amplification was detected in 16 patients,the detection rate of mutation was 36.4%.Among the mutation types,EGFR L861 Q had the highest mutation abundance,EGFR T790 M had the lowest mutation abundance,and EGFR 19 del and EGFR L858 R had significant differences,P=0.037,with statistical significance.3.4 Types of TP53 Mutation in Lung Cancer SamplesIn this study,the mutation frequency of TP53 was 45.2%.According to the functional domain of TP53,although most TP53 mutations are concentrated in DNA binding region,TP53 mutations in non-DBD region tend to coexist with EGFR mutations,and the difference is statistically significant(P=0.027).3.5 KRAS mutation types in lung cancer samplesIn this study,6 cases of KRAS gene mutation,mutation frequency was 14.3%,the average mutation abundance was 7.66%.Among them,3 cases of KRAS mutation combined with EGFR mutation.Conclusion:1.For first-line chemotherapy patients,the prognosis of EGFR E19 deletion mutation patients is better than that of EGFR negative patients.The prognosis of first-line targeted therapy in patients with EGFR mutation is better than that of first-line chemotherapy.Gene testing is very important.2.A variety of different signaling pathways are involved in the evolution of lung cancer.For patients with multi-target co-mutation,standard therapy is not effective.