Correlation Analysis Between Driver Genes And Clinical Characteristics And Correlation Analysis Between Driver Genes And PD-L1 In Non-small Cell Lung Cancer

Objective: The purpose of this article is to determine the mutations of driver genes in patients with non-small cell lung cancer by next-generation sequencing.To explore the relationship between driver genes and clinical characteristics,and to explore the relationship between driver genes and PD-L1,a predictive marker for the efficacy of immunotherapy.At the same time,the survival of patients with EGFR mutation was followed up.Expect to providing assistance to clinical work.Methods:Patients with non-small cell lung cancer who were genetically tested at the Fourth Hospital of Hebei Medical University from October 2018 to October 2019 were selected and included in this study.That is,patients with non-small cell lung cancer confirmed by histology or cytology and lung cancer-related genes detected by next-generation sequencing.Through tissue,pleural effusion,or blood gene tests,the types of genetic mutations were identified,and PD-L1 tests were improved at the same time.Patients' clinical information was collected,and appropriate treatments were selected based on the results of the gene tests.Results: A total of 300 NSCLC patients were included in the study from October 2018 to October 2019,with 49.67%(149/300)of males and 60.33%(181/300)of age greater than 60,with an average age of 60.81±10.37 years.Non-smoking accounted for 61.33%(184/300);adenocarcinoma accounted for 94.00%(282/300);stage III and IV accounted for 87.67%(263/300).In 300 patients,the mutation status of the driver gene and its relationship with clinical characteristics were analyzed separately.Patients with EGFR mutations accounted for 59.67%.EGFR mutations mostly occurred in non-smoker women(P<0.001),adenocarcinoma(P=0.004),and stage and ?IV(P=0.011)patients.ALK fusion patients accounted for 6.00%,and ALK fusion mostly occurred in patients less than 60 years of age(P=0.016).RET fusion patients accounted for 2.00%,and RET fusion was more common in female patients(P=0.03).KRAS mutations accounted for 14.67%.KRAS mutations mostly occurred in male(P<0.001),60 years old or older(P=0.013),and smoking(P<0.001)patients.PIK3 CA mutation or amplification patients accounted for 9.00%.PIK3 CA mutations or amplification were common in patients with smoking(P=0.007),men(P=0.008),and squamous cell carcinoma(P<0.001).In this study,132 patients were also tested for PD-L1,and the detection rate was 44.00%.Among them,71 patients used two PD-L1 detection kits at the same time,and analyzed the difference between the two different PD-L1 detection kits,and found that the SP263 detection kit PD-L1 positive rate(63.4%)was higher than the 22C3 detection kit(47.9%).And analyze the relationship between EGFR,KRAS,ALK and PD-L1,and found that the expression rate of PD-L1 is higher in EGFR wild-type patients(P=0.014).Of the 179 patients with EGFR mutations,132 patients received single-targeted drug therapy.The survival time of patients was followed up,and the survival curve was drawn.As of January 1,2020,the median progression-free survival was 13.43 months(95% CI: 11.58-15.28months).According to EGFR single point mutation,compound mutation,and EGFR combined with other gene mutations,they were divided into three groups for analysis.The median progression-free survival of the single point mutation group was 13.47 months(95% CI: 10.96-15.98 months),and compound mutations.The median progression-free survival of the group was 14.00 months(95% CI: 5.83 to 22.17 months),and the median progression-free survival of the other gene mutation group was 11.47 months(95% CI: 8.66 to 14.28 months).But the difference between the three groups is not statistically significant(P=0.386).Among the EGFR mutation patients,there were 24 dead patients.According to the presence or absence of classic mutations,the 24 patients were grouped.The median overall survival of the classic mutation group and the rare mutation group was 9.00 months(95% CI: 6.25 months-11.76 months)and 3.83 months(95% CI: 2.89 to 4.77 months).The survival time of the classical mutation group was longer than that of the rare mutation group(P=0.003).Conclusions:1.In the real world,EGFR gene mutations account for 59.67% of NSCLC patients,ALK gene fusions account for 6.00%,RET fusions account for 2.00%,KRAS gene mutations account for 14.67%,ROS1 fusions account for 3.67%,HER2 Mutations accounted for 4.00%,MET mutations or amplification accounted for 5.67%,BRAF mutations accounted for 2.33%,PIK3 CA mutations or amplification accounted for 9.00%,NRAS gene mutations accounted for 1.00%.In addition,rare genes such as ESR1,KIT,UGT1A1,and GRIK2 were found in NSCLC patients.2.In NSCLC patients,EGFR gene mutations mostly occur in women,non-smokers,stage III and IV adenocarcinoma patients.ALK fusion occurs mostly in patients <60 years of age.KRAS mutations mostly occur in males,?60 years old,smoking patients.RET fusion is common in female patients.PIK3 CA mutation or amplification is common in male squamous cell carcinoma patients who smoke.3.PD-L1 expression rate is higher in patients with EGFR wild-type NSCLC.4.Compared with patients with rare mutations,patients with NSCLC with classical mutations of EGFR have a longer survival time.