【摘要】 目的:探讨EGFR和KRAS突变在未经系统酪氨酸激酶抑制剂(tyrosine kinases inhibitors,TKIs)治疗的非小细胞肺癌(non-small cell lung cancer,NSCLC)患者中的预后预测价值。方法:收集56例未经过系统TKIs治疗的NSCLC患者手术组织样本,通过液相芯片技术进行EGFR与KRAS突变检测,随访2.9~30.0个月,收集患者的临床资料与死亡资料,分析患者2年生存率。结果:56例NSCL组织中,19例(33.9%)存在EGFR突变,其中9例为E19突变,10例为E21突变;8例(14.3%)存在KRAS突变,其中7例为E2突变,1例为E3突变。单因素分析显示,携带KRAS突变的患者2年生存率低于KRAS无突变患者,P=0.023 2;而EGFR突变的患者2年生存率高于EGFR无突变患者,但差异无统计学意义,P=0.060 5。双基因分析显示,3组NSCLC患者的2年生存率差异有统计学意义,P=0.033 9。组间比较显示,EGFR E19/E21突变组2年生存率优于KRAS E2/E3突变组,校正P=0.031 5,EGFR E19/E21突变组与野生型组、KRAS E2/E3突变组与野生型组的2年生存率均差异无统计学意义,校正P值分别为0.506 0和0.628 6。多因素Cox回归分析显示,KRAS突变与KRAS和EGFR综合突变情况是NSCLC患者2年生存率的独立预测因子。其中,KRAS突变/KRAS无突变,P=0.037;EGFR E19/E21突变组/KRAS E2/E3突变组,P=0.039。结论:KRAS突变与KRAS和EGFR综合突变情况是未经系统TKIs治疗NSCLC患者生存的独立预测因子,对患者预后具有指示意义。更多还原

【Abstract】 OBJECTIVE:To investigate predictive value of the epidermal growth factor receptor(EGFR)and KRAS gene mutations in the prognosis of non-small cell lung cancer(NSCLC)patients who did not accept systemic tyrosine ki-nases inhibitors(TKIs)treatment.METHODS:Totally 56resected NSCLC tissue samples were collected from patients who did not accept systemic TKIs treatment.The samples were detected by liquidchip techonology for EGFR and KRAS mutations.Clinical and death data were collected duringfollow-up period 2.9-30.0months,and 2-years survival rate was analyzed.RESULTS:Among 56samples,EGFR mutations were found in 19samples(33.9%),including exon 19muta-tions in 9samples and exon 21(L858R)mutations in 10samples.KRAS mutations were found in 8samples(14.3%), with exon 2mutation in 7samples and exon 3mutation in 1sample.Patients with KRAS mutations had lower 2-years sur-vival rate compared to those without mutations(P=0.023 2).Patients with EGFR mutations had higher 2-years survival rate than those without mutations,however it didn’t achiev statistical significance(P=0.060 5).The 2-years survival rate was statistically different among 3groups(P=0.033 9).Further group-group comparison showed that the 2-years surviv-al rate of EGFR E19/E21mutation was significantly better than that of the KRAS E2/E3mutation group,adjusted P= 0.031 5.There was no statistical differences between EGFR E19/E21mutation group and non-mutation group(adjusted P=0.506 0),KRAS E2/E3mutation group and non-mutation group(adjusted P=0.628 6).Multivariate analysis by the Cox proportional hazards model revealed that both KRAS mutations and bi-gene mutations were the independent predictive factor for NSCLC survival(KRAS mutation/KRAS wild-type(P=0.037);EGFR E19/E21 mutation/KRAS E2/E3 mutation(P=0.039).CONCLUSION:KRAS mutations and bi-gene mutations of KRAS and EGFR are independent pre-dictive factors of survival and indicators of prognosis for patients without systemic TKIs treatment.更多还原