| Objective:In order to solve the problem of low delivery rate of genetic testing caused by factors such as high cost,relatively long time consuming,and relatively difficult pathological materials for clinical lung cancer gene mutation detection.This article aims to study the relationship between the expression of immunohistochemical indexes TTF-1,NapsinA,CK7,P63,P40,clinical pathological characteristics,chest CT imaging characteristics,and tumor marker expression levels and EGFR mutations in patients with non-small cell lung cancer.This provides a basis for predicting the EGFR mutation status and formulating better treatment plans for lung cancer patients.Methods:According to the inclusion and exclusion criteria,this study included 65 patients diagnosed with non-small cell lung cancer in the Department of Respiratory and Critical Care Medicine and Cardiothoracic Surgery of Calmette Hospital of Kunming Medical University from November 2019 to February 2021.These patients were confirmed by pathological diagnosis and genetic testing.We performed statistical analysis on the correlation between the expression of the above immunohistochemical indicators,clinicopathological characteristics,CT imaging characteristics,tumor marker expression levels and EGFR mutations.And the difference is statistically significant(P<0.05).Results:1.The EGFR mutation rate in lung adenocarcinoma was 52.63%(30/57).The mutation sites are mainly exon 19 and exon 21,and the two mutations account for 80%,the mutation rate of EGFR in Squamous cell carcinoma was 12.50%.EGFR mutations were higher in women than men(P<0.05),non-smokers were higher than smokers(P<0.05),the differences were statistically significant(P<0.05);There was no correlation between the patients’ long-term residence,age,TNM stage and EGFR mutation,and the difference was not statistically significant(P>0.05).2.TTF-1 positive expression had more EGFR mutation rate than TTF-1 negative expression in lung adenocarcinoma.TTF-1 has a sensitivity of 100%for predicting EGFR mutations,a specificity of 26%,a negative predictive value of 100%,and a positive predictive value of 60%.The mutation rates of NapsinA positive and negative expressing EGFR in patients with lung adenocarcinoma were 58%and 22%,but the difference was not statistically significant(P=0.05).The expression of CK7,P63,P40 was not correlated with EGFR mutation,and the difference was not statistically significant(P>0.05).3.In lung adenocarcinoma patients with TTF-1 negative or TTF-1 and NapsinA double-negative immunohistochemical indexes,there was no case of EGFR gene mutation,but 86%of these patients had KRAS gene mutation.4.In lung adenocarcinoma,the positive expression rate of TTF-1 was 88%(50/57),the positive rate of NapsinA was 84%(48/57),the positive rate of CK7 was 98%(56/57),and the positive rate of P63 and P40 were 4%(2/57)and 5%(3/57)respectively;In lung squamous cell carcinoma,the positive rate of P63 expression was 100%,the positive rate of P40 was 100%,and there was no expression of CK7,TTF-1 and NapsinA.5.The EGFR mutation rate(65%)of patients with burr syndrome was higher than that of patients without burr syndrome(42%),and the difference was statistically significant(P<0.05).Ground glass shadow,pleural thickening sign,lobular characteristics,tumor location,atelectasis,mediastinal lymphadenopathy,pleural effusion sign.tumor diameter.and EGFR mutation are not correlated.and the difference is not statistically significant(P>0.05).6.The expression level of CEA in the EGFR mutation group was 13.15(3.98.36.44)ng/ml,which was higher than the expression level of the wild group by 4.42(1.39,12.20)ng/ml.There was a statistically significant difference in the expression level of CEA between the two groups(P<0.05).The expression levels of NSE,CYFR21-1,SCCA,CA125,CA-199,ProGRP,CA-]53 were not significantly different between the EGFR mutation group and the wild group(P>0.05).Conclusions:1.EGFR mutations are more common in women,non-smokers,and adenocarcinoma patients.The mutation sites are mainly exon 19 deletions and exon 21 point mutations.Patients with burr imaging features are more likely to have EGFR gene mutations,and those with EGFR mutations have higher CEA levels than those without mutations.2.Immunohistochemical markers TTF-1,NapsinA,CK7,P40 and P63 can be used for the diagnosis and differential diagnosis of lung cancer.3.Patients with TTF-1 positive expression in lung adenocarcinoma have a higher EGFR mutation rate.The negative expression of TTF-1 has a very high negative predictive value for EGFR.When immunohistochemistry is negative for TTF-1 in lung adenocarcinoma,it is suggested that the possibility of EGFR mutation is very low,which has certain scientific significance and clinical application value. |
