EGFR和K-ras基因表达突变与非小细胞肺癌预后的关联分析

目的探讨EGFR和K-ras基因表达突变与非小细胞肺癌(NSCLC)预后的关系。方法纳入126例NSCLC患者,使用免疫组织化学染色和基因测序检测其肿瘤组织EGFR和K-ras基因的表达突变情况,按NCCN指南对患者进行标准治疗和随访,采用Kaplan-Meier曲线、Log rank检验和Cox比例风险模型分析不同基因表达突变患者的中位生存期、5年总生存率和生存期的影响因素。结果 EGFR基因的阳性表达率为49.21%,突变率为28.57%,K-ras基因的阳性表达率为42.06%,突变率为2.38%;K-ras(+)的中位生存期和5年总生存率均显著低于K-ras(-)患者(χ2=4.348,Log-rank P=0.037),EGFR(突变)的中位生存期和5年总生存率均显著高于EGFR(野生)患者(χ2=11.518,Log-rank P=0.001);双基因阳性(P=0.027,HR=2.584,95%CI:1.113~6.002)和远处转移(P=0.046,HR=2.104,95%CI:1.013~4.369)是影响NSCLC患者生存期的危险因素,使用靶向药物治疗是生存期的保护因素(P0.001,HR=0.293,95%CI:0.149~0.574)。结论 EGFR和K-ras基因的表达突变与NSCLC患者的预后密切相关,双基因阳性可降低患者生存时间,它们是患者个体化用药和预后判断的重要指标。

Association analysis between EGFR and K-ras gene expression and prognosis in non small cell lung cancer

Objective To explore the association of EGFR and K-ras gene expression and mutation with prognosis in non-small cell lung cancer(NSCLC). Methods 126 patients with NSCLC were included and treated with NCCN guidelines, and immunohistochemistry and gene sequencing were used to detect the expression and muta-tion of EGFR and K-ras gene in cancer tissues of these patients, then Kaplan-Meier curves, Log rank test and Cox proportional hazards model were used to analyze the difference of survival in patients with different expression and mu-tation in EGFR and K-ras. Results The positive and mutating rate of EGFR was 49. 21% and 28. 57%, while K-ras was 42. 06% and 2. 38%. The middle survival and 5-year survival rate in K-ras(+)was significantly lower than that in K-ras(-)patients(χ2 =4. 348, P=0. 037). The middle survival and 5-year survival rate in EGFR(muta-tion)was significantly higher than that in EGFR(wild)patients(χ2 =11. 518, P=0. 001). EGFR+-K-ras+(P=0. 027, HR=2. 584, 95%CI:1. 113~6. 002)and distant metastasis(P=0. 046, HR=2. 104, 95% CI:1. 013~4. 369)were the risk factors of survival, while the use of targeted therapy was the protective factor of survival(P<0. 001, HR=0. 293, 95% CI: 0. 149 ~0. 574). Conclusion The expression and mutation of EGFR and K-ras gene is closely related with the prognosis of NSCLC patients, and two gene-positive can reduce the survival time of pa-tients, so they are the important indicators for individualized treatment and prognosis of NSCLC.