The Relationship Between EGFR Gene Mutation In Tissues And Blood Form The Patients Of Lung Adenocarcinoma And Clinicopathological Features And Short-term Efficacy Of TKI Therapy

Objectives1 To investigate the relationship between EGFR gene mutation and clinicopathological characteristics of patients with primary lung adenocarcinoma,and to investigate the correlation of EGFR gene mutation among the expression of ALK protein,c-met protein and ROS-1 protein.2 To investigate the relationship between T790M mutation in plasma of patients with advanced lung adenocarcinoma treated with EGFR-TKI and short-term efficacy of TKI,In order to provide theoretical basis for targeted therapy and mechanism of progression of lung adenocarcinoma.Methods 1 The specimensof primary lung adenocarcinoma resected in Tangshan GongRen Hospital from March 2016 to December 2017 were retrospectively collected(n=206).The mutation of EGFRgene was detected by real-time PCR.The relationship between the EGFR gene mutation and clinicopathological characteristics was analyzed by?~2 test or Fisher's exact test.The expression of ALK protein(n=140),c-met protein(n=86)and ROS-1protein(n=63)were detected by immunohistochemistry.The correlation amongEGFR gene mutation and the expression of ALK,c-met,ROS-1 proteins was analyzed by spearmanrank correlation.259 patients with lung adenocarcinoma treated with EGFR-TKI and had clinical progress from January 2016 to November 2017 in Tangshan GongRen Hospital were collected.Real-time PCR was used to detect the mutation of T790M.Multivariate Cox regression model was used to analyze the relationship between the mutation and Progression-free survival.Results1The mutation rate of EGFR gene in lung adenocarcinoma was related to gender,smoking history and pleural invasion.The mutation rate of EGFR gene in female(56.9%)was higher than that in male(42.2%,P=0.037),the mutation rate of EGFR gene in non-smokers(55.2%)was higher than that in smokers(39.7%,P=0.040),the mutation rate of EGFR gene in pleural invaders(63.8%)was higher than that in non-pleural invaders(45.3%,P=0.017).However,the mutation of EGFRgene was not related to the age,location,T stage,lymph node metastasis and clinical stage(P>0.05).2 The mutation rate of EGFR gene in lung adenocarcinoma is related to histological subtypes.The mutation rate of EGFR gene in lung adenocarcinoma with acinar component(63.0%)was higher than that without acinar component(33.3%,P<0.001).The mutation rate of EGFR gene in lung adenocarcinoma with papillary component(69.4%)was higher than that without papillarycomponent(42.4%,P<0.001).The mutation rate of EGFRgene in lung adenocarcinoma was no significant difference amongthe lung adenocarcinoma with lepidic,solid and micropapilla component(all P>0.05).3 The mutation rate of EGFR gene in lung adenocarcinoma was negatively correlated with the expression of ALK protein(r=-0.721,P=0.035),but was not correlated with the expression of ROS-1 proteinand c-met protein(all P>0.05).4 After EGFR-TKI treatment,the median PFS(9.8 months)of T790M mutation was shorter than that of non-mutation patients(13.6 months,P=0.020),and T790M mutation was an independent predictor of short-term efficacy of lung adenocarcinoma.Conclusions1EGFR gene mutation is prone to occur in female,non-smoking,pleural invasion,acinar and papillary lung adenocarcinoma patients.2The mutation of EGFR gene in lung adenocarcinoma was negatively correlated with the expression of ALK protein.3T790M mutation is an independent predictor of short-term efficacy in patients with acquired drug resistance of lung adenocarcinoma.Figure12;Table13;Reference 75...