【摘要】 目的根据2011年国际肺癌研究协会、美国胸科学会和欧洲呼吸学会发布的肺腺癌国际多学科分类(简称新分类)标准,评估新分类法与EGFR突变之间的相关性。方法收集2010～2012年肺腺癌标本共292例,其中145例手术标本分别使用新分类和WHO(2004版)分类(简称WHO分类)进行组织分型,并用基因直接测序法对所有标本EGFR基因外显子18～21(E18～21)进行检测。结果有123例(42.1%)标本发生EGFR突变,新分类法中各组织学亚型之间突变情况不同(P=0.006),EGFR突变多发于贴壁、微乳头为主的肺腺癌,含贴壁结构、乳头结构和微乳头结构亚型的肺腺癌,少见于腺泡、实体为主伴黏蛋白型(实体为主)及含浸润变异结构的肺腺癌。按WHO分类各亚型之间EGFR突变无明显差异。结论新分类表现出与分子诊断的相关性,其提倡的按5%增量的半定量方式将>5%的各组织学亚型及其所占百分比全面计入诊断(5%增量半定量法)的综合分类法应该被推广。更多还原

【Abstract】 Purpose To assess the correlation of epidermal growth factor receptor( EGFR) mutations with the new classification of lung adenocarcinoma( the International Multidisciplinary Classification of Lung Adenocarcinoma) proposed by the International Association for the Study of Lung Cancer,American Thoracic Society and the European Respiratory Society in 2011. Methods 292 cases of lung adenocarcinoma with detailed medical record and conventional wax block were collected between 2010 ～ 2012 in the tumor hospital of Shanxi province,which included surgical specimens,puncture specimens and pleural effusion sediment samples. EGFR exon 18 ～21 mutations of all cases were detected by direct sequencing method while 145 surgical specimens were been reclassified with the new classification and WHO classification. Results EGFR mutations were found in 123 cases( 42. 1%),and the mutation rate in the histological subtypes of the new classification was not the same( P = 0. 006). EGFR mutations more commonly occurred in the specific subtypes of pulmonary adenocarcinomas including lepidic-predominant,micropapillary-predominant subtype,or subtypes wtih lepidic,papillary or micropapillary components. Conversely,rare mutations were in acinar-predominant,solid-predominant and various component subtypes. Additionally,EGFR mutations in the subtypes of WHO classification had no significant difference. Conclusion The new classification has a correlation with molecular diagnostics,which advocates that the percentages of each subtype greater than 5% in tumor tissue should be described in pathological diagnosis,called 5% incremental semi-quantitative method,which need to be popularized.更多还原