【摘要】 目的检测晚期非小细胞肺癌患者化疗前后血清EGFR基因外显子19和外显子21的突变状态,探讨化疗药物对血清EGFR基因突变状态的影响。方法 48例非小细胞肺癌患者均接受了至少4-6周期的全身化疗,应用磁珠法提取患者化疗前后的血清游离DNA,RT-PCR技术扩增患者血清游离DNA中EGFR外显子19和外显子21,所有扩增样本均经基因测序法验证EGFR基因突变状态,分析EGFR基因外显子19和外显子21化疗前后突变状态。结果 48例肺癌患者化疗前后血清EGFR的突变以外显子21为主,化疗前后外显子19和外显子21的突变率无显著性差异(P>0.05),血清EGFR的突变状态与患者病理类型具有相关性(P<0.02),但与性别无关(P>0.05),化疗前血清EGFR基因突变率为35.4%(17/48),化疗后血清EGFR基因突变率为43.8%(21/48),化疗前后患者EGFR基因突变的一致率为62.5%(30/48),化疗前后EGFR基因的突变率无统计学差异(P>0.05),在不一致的18例患者中,7例患者由化疗前的EGFR突变阳性变为阴性,11例患者由化疗前的EGFR突变阴性变为阳性。结论化疗药物可能导致肺癌患者血清EGFR基因突变的改变,对于一线化疗后拟应用EGFR-TKI治疗的患者宜动态观察血清EGFR基因的变化,避免患者治疗的盲目性。更多还原

【Abstract】 Objective To detect EGFR exon 19 and exon 21 mutation status in serum before and after chemotherapy from advanced non-small cell lung cancer patients,and evaluate the effect of chemotherapy on EGFR mutation status. Methods Magnetic beads were used for DNA extraction in serum of 48 advanced non-small cell lung cancer patients before and after chemotherapy. The EGFR was amplified by RT-PCR and all samples were analyzed by direct sequencing and the changes of EGFR exon 19 and exon 21 mutations were observed before and after chemotherapy. Results The rate of serum EGFR exon 21 mutations in 48 patients was higher than that of exon 19,but there was no significant difference( P > 0. 05). The rates of EGFR mutations showed no significant difference between male and female( P > 0. 05),but there was significant difference between adenocarcinoma and squamous cell carcinoma( P < 0. 02).EGFR mutations were found in 35. 4%( 17 /48) and 43. 8%( 21 /48) in serum before and after chemotherapy respectively,and there was no significant difference( P > 0. 05),The consistency rate of EGFR mutation before and after chemotherapy was 62. 5%( 30 /48). Among 18 discordant cases,11 cases changed from wild type to mutant type after chemotherapy,and 7 cases changed from mutant type before chemotherapy to wild type after chemotherapy. Conclusion Chemotherapy drugs may have influence on serum EGFR mutation in advanced carcinoma patients. It is important for lung cancer patients with first-line chemotherapy to detect serum EGFR gene mutation before EGFR-TKI treatment.更多还原