非小细胞肺癌组织P^(53)基因突变的研究

本文旨在研究非小细胞肺癌患者发生抑癌基因P53基因的突变量的状况，经采用PCR-SSCP法分析63例非小细胞肺癌和5例正常胎儿肺组织在外显予5、6、7和8中发生的点突变，NSCLC总突变率为49．2％（31／63）。5例正常胎肺组织未出现P53基因突变，63例NSCLC患者中，37例磷癌，16例为腺癌和10例鳞除混合癌，其突变率分别为48．6％，50％和50．0％，与肿瘤组织类型无关。Ⅰ期19例，Ⅱ期22例和Ⅲ例22例，其突变率分别为47.5％，45．4％和54．5％，Ⅲ期突变率稍高，但无统计学意义。本结果证明肺癌组织存在P53基因点突变可能为肺癌发生的关键基因之一。     

中国肺癌患者EGFR基因的突变研究

目的 观察中国非小细胞肺癌（NSCLC）患者EGFR基因突变情况及其与临床特征、病理间的关系。方法 采用PCR扩增和DNA测序技术分析NSCLC中EGFR基因第19和21号外显子突变情况。结果 75例NSCLC中,有13例（17．3％）酪氨酸激酶域存在体细胞突变,其中7例（9．3％）为发生于第19号外显子的缺失突变,6例（8．0％）为发生于第21号外显子的替代突变。腺癌突变率为38．7％（12／31）,高于支气管肺泡癌（1／10）、腺鳞癌（0／5）、肺母细胞瘤（0／2）、大细胞癌（0／1）和鳞癌（0／26）;女性患者突变率为30．0％,高于男性患者（8．9％）;非吸烟患者突变率为28．2％,高于长期吸烟者（5．6％）。结论在中国NSCLC中,EGFR基因突变率以腺癌、女性及非吸烟者较高。     

原发性非小细胞肺癌中K－ras基因突变的研究

目的探讨非小细胞肺癌（Non－smallcelllungcancer,NSCLC）组织中K－ras第12密码子点突变与NSCLC发生和发展的相关性。方法采用针对K－ras基因第12密码子特异点突变方式的引物进行PCR及银染法,分析175例新鲜NSCLC手术切除标本、43例癌旁组织及5例良性肺部疾患组织中K－ras基因第12密码子中CGT、GTT和GAT三种不同点突变方式。结果175例NSCLC组织中出现K－ras12密码子GGT→CGT突变率为34．86％（61／175）,GGT→GTT突变率40．57％（71／175）及GGT→GAT突变率37．71％（66／175）,总突变率为62．3％（109／175）。其中,同时出现CGT／GTT二个点突变为10．1％(11／109),CGT／GAT9．2％(10／109),GTT／GAT12．8％(14／109),而CGT／GTT／GAT均出现突变占23．9％(26／109)。其中Ⅰ期、Ⅱ期、Ⅲ期突变率分别为64．3％、56．8％及64．0％,另外腺癌突变率为63．8％、鳞癌为60．5％及腺鳞癌为64．5％,因此K－ras点突变与肺癌的分期及病理类型均无相关性（P＞0．05）。然而,37例腺癌突变组中出现GTT／GAT突变率为17．2％(10／58)明显高于鳞癌的3．5％(3／86),二者具有明显差异（P＜0．01）。43例癌旁组织与5例良性肺部疾患组织均未发现K－ras点突变。结论K－ras12密码子点突变及多点突变普遍存在于NSCLC中,其中肺腺癌出现GTT／GAT二个点突变明显高于鳞癌,结果提示K－ras基因点突变是肺癌发生和发展的一个重要因素。     

人小细胞肺癌P^53基因突变的研究

为探讨小细胞肺癌（SCLC）发生的分子机制，应用免疫组化和聚合酶链反应─-单链构象多态性（PCR－SSCP）技术，对14例SCLC的石蜡切片标本进行了P53基因突变研究。结果显示：P53蛋白免疫组织化学反应有9例出现阳性，其中2例为十，7例为～，阳性率为64．3％（9／14）。P53基因第5、6、7、8外显子突变率分别为21．4％（3／14）；14，3％（2／14）;14．3％（2／14）；7．1％（1／14），总突变率为57．1％（8／14）。提示：SCLC中存在较高的P53基因突变率，P53基因突变在人类肺癌的发生发展过程中起着重要的作用。     

原发性非小细胞肺癌中K-ras基因突变的研究

目的：探讨非小细胞肺癌（Non－small cell lung cancer NSCLC）组织中K－ras第12密码子点突变与NSCLC发生和发展的相关性。方法：采用针对K－ras基因第12密码子特异点突变方式的引物进行PCR及银染法,分析175例新鲜NSCLC手术切除标本、43例癌旁组织及5例良性肺部疾患组织中K－ras基因第12密码子中CGT、GTT和GAT三种不同点突变方式。结果：175例NSCLC组织中出现K－ras 12密码子GGT→CGT突变率为34．86％（61／175）,GGT→GTT突变率40．57％（71／175）及GGT→GAT突变率37．71％（66／175）,总突变率为62．3％（109／175）。其中,同时出现CGT／GTT二个点突变为10．1％ 11／109CGT／GAT 9．2％10／109 GTT／GAT 12．8％ 14／109,而 CGT／GTT／GAT均出现突变占23．9％26／109。其中Ⅰ期、 Ⅱ期、Ⅲ期突变率分别为64．3％、56．8％及64．0％,另外腺癌突变率为63．8％、鳞癌为60．5％及腺鳞癌为64．5％因此K－ras点突变与肺癌的分期及病理类型均无相关性（P＞0．05）。然而,37例腺癌突变组中出现GTT／GAT突变率为17．2％ 10／58明显高于鳞癌的3．5％3／86二者具有明显差异（P＜0．01）。43例癌旁组织与5例良性肺部疾患组织均未发现K－ras点突变。结论：K－ras12密码     

老年晚期非小细胞肺癌患者ＥＧＦＲ基因的突变研究

目的　探讨老年晚期非小细胞肺癌（ＮＳＣＬＣ）患者ＥＧＦＲ基因突变情况及其与临床病理特征之间的关系。方法　采用ＰＣＲ扩增和实时荧光ＰＣＲ技术分析ＮＳＣＬＣ中ＥＧＦＲ基因第１９和２１号外显子的突变情况。结果　８６例老年ＮＳＣＬＣ酪氨酸激酶域存在体细胞突变２５例（２９.１％）,其中第１９号外显子的缺失突变为１３例（１５.１％）,第２１号外显子的替代突变为１２例（１４.０％）。肺腺癌、肺泡癌的突变率为３６.４％（２４／６６）,高于鳞癌的６.３％（１／１６）;女性患者突变率为４８.３％（１４／２９）,高于男性患者的１９.３％（１１／５７）;非吸烟患者的突变率为４３.９％（１８／４１）,高于长期吸烟者的１５.６％（７／４５）。结论 中国老年ＮＳＣＬＣ患者ＥＧＦＲ基因酪氨酸激酶区第１９和２１外显子的突变特征与肺癌总体患者类似,与年龄关系不大,突变率以腺癌、女性及非吸烟者较高。老年ＮＳＣＬＣ患者同样可以通过基因检测获得ＴＫＩ治疗预测信息。     

非小细胞肺癌EGFR基因突变的临床意义研究

  目的   探讨非小细胞肺癌EGFR基因外显子突变与其临床病理特征的关系。   方法   利用ADx-ARMS?EGFR基因突变检测试剂盒,检测214例未接受过Gefitinib治疗的非小细胞肺癌患者组织中EGFR基因外显子18、19、20和21突变。   结果   非小细胞肺癌组织中EGFR基因总突变率为45.8%（98/214）,外显子18、19、20和21的突变率分别为0.93%（2/214）、22.0%（47/214）、2.3%（5/ 214）和20.6%（44/214）。另有2例19和21外显子双重突变。EGFR基因在肺腺癌组织中的总突变率为50.3%（93/185）明显高于肺鳞状细胞癌17.2%（5/29）（P=0.001）。EGFR基因在女性患者中的突变率57.0%（57/100）高于男性36.0%（41/114）（P=0.002）,EGFR基因在NSCLC淋巴结转移患者中的突变率（66.7%）显著高于无淋巴结转移患者（39.5%）（P < 0.05）,但EGFR基因突变率与肺癌患者的年龄、肿瘤分级和临床分期均无显著性差异（P>0.05）。   结论   中国肺癌尤其是肺腺癌患者存在EGFR基因的较高突变率,EGFR外显子19、21突变结合肺癌的临床病理特征有望成为评估TKI治疗非小细胞肺癌疗效的分子标志。      

肺腺癌p53基因突变与临床病理特征关系的研究

目的探讨p53基因在肺腺癌中突变的频率、位置和在肺腺癌发生发展中的作用及与其临床病理特征的关系。方法聚合酶链式反应一单链构象多态性（PCR－SSCP）检测31例肺腺癌的P53基因第5～8外显子突变。结果14例（45％）出现P53基因5～8外显子突变，其中7、8外显子突变占73％。P53基因突变男性显著高于女性（P—0．003），在肿瘤≤3cm的病例p53基因突变率显著低于肿瘤＞3cm的病例（P=0．005）。p53基因突变与吸烟史、年龄、组织学类型、分化程度、淋巴结状况、国际病理TNM分期及瘤栓无显著性差异（P＞0．05）。结论肺腺癌中P53突变率为45％，主要分布在第7、8外显子，P53基因突变参与肺腺癌癌变的始动和腺癌的进展。     

ADx-ARMS方法检测晚期非小细胞肺癌患者胸水标本癌细胞基因突变的临床意义

目的:探讨应用ADx-ARMS方法检测非小细胞肺癌患者胸水标本癌细胞基因突变应用于指导小分子EGFR酪氨酸激酶抑制剂（EGFR-TKIs）治疗的可行性与临床意义。方法:ADx-ARMS检测24例非小细胞肺癌患者胸水标本EGFR基因第19、20和21外显子突变与KRAS基因第2外显子突变。统计分析胸水标本与前期检测过的非小细胞肺癌组织中的EGFR、KRAS突变率差异。结果:24例胸水标本中,EGFR突变与KRAS突变分别为14例（58.3%）和1例（4.2%）。前期检测过的非小细胞肺癌组织EGFR和KRAS突变率分别为47.6%和4.5%。EGFR和KRAS突变率在胸水标本与前期肺癌组织中差异无统计学意义（P>0.05）。结论:对失去手术机会而难以获得组织标本的晚期非小细胞肺癌患者,可应用ADx-ARMS方法选择胸水标本筛查EGFR、KRAS基因突变,从而指导EGFR-TKIs的临床应用。     

非小细胞肺癌中p53基因突变的初步研究

为了解非小细胞肺癌中ｐ５３基因突变的情况，应用改良聚合酶链反应－单链构象多态（ＰＣＲ－ＳＳＣＰ）银染技术检测１７例非小细胞肺癌中ｐ５３基因第５～８外显子的突变情况，有８例存在ｐ５３基因突变，突变率为４７．００％（８／１７），其中鳞癌为５５．５６％（５／９），腺癌为３７．５０％（３／８）。本研究结果表明：非小细胞肺癌中ｐ５３基因突变较为常见；改良后的ＰＣＲ－ＳＳＣＰ银染技术对非小细胞肺癌的基因诊断具有潜在性应用价值     

Gender differences in p53 mutational status in small cell lung cancer

Mutations in the p53 tumor suppressor gene have been demonstrated to be one of the most frequent genetic abnormalities in human cancers. Previous studies have shown that the frequency of p53 mutations is significantly higher in small cell lung cancer than in non-small cell lung cancer. However, this conclusion was based in large part on data derived from tumor cell lines and from studies with relatively small sample sizes and biased gender populations. To determine the mutational frequency in the p53 tumor suppressor gene and a potential difference in gender, we analyzed primary small cell lung cancer tumors from 65 patients (37 males and 28 females) for p53 mutations between exons 5 and 9. Mutations were found in 37 of 65 tumors (57%) within the region of p53 analyzed. Interestingly, none of the tumors from females contained more than one mutation, whereas four of the tumors from males contained more than one mutation. The most common mutation in this population was an adenosine-to-guanine transition (27%), followed by guanine-to-thymidine transversion (17%) and guanine-to-adenosine transition (12%). The gender difference in p53 mutational rate identified in this study suggests that a higher proportion of female tumors may develop through pathways not involving p53 mutations.     

Expression of mutant p53 proteins in lung cancer correlates with the class of p53 gene mutation.

We investigated the immunocytochemical staining and immunoblotting characteristics of 33 different p53 mutant proteins identified in lung cancer cell lines (18 small-cell lung cancer and 15 non-small-cell lung cancer) using monoclonal antibodies pAbs 240, 421 and 1801. The p53 mutants studied were representative of those found in lung cancer and included three deletions, four nonsense, seven splicing and 19 missense lesions. Control cell lines included six B-lymphoblastoid cell lines and two lung cancer cell lines without p53 mutations. Immunocytochemistry demonstrated 16 cell lines (48%) with definite overexpression of p53 protein (the high-expresser group of mutants), while in the remainder of cases either no p53 expression or low levels of p53 protein expression were found (the low-expresser group of mutants). The type of p53 mutation correlated with the expresser group. High expressers all had p53 missense mutations in exons 5-8, and immunocytochemistry identified 16/17 (94%) of these mutants. Several classes of p53 mutations occur in the low-expresser groups: deletions, splicing mutants, nonsense mutants and missense mutations outside of exons 5-8 all resulted in very low or undetectable levels of p53 protein. We conclude that there are low- and high-expression groups of p53 mutants in lung cancer and that the detection of protein expression in tumor cells by immunocytochemistry and immunoblotting is dependent upon the type of mutation of the p53 tumor-suppressor gene.     

贲门癌端粒酶活性表达及与p53基因突变关系的研究

Objective: To study the relationship of the telomerase activity and the p53 gene mutation in cardiac cancer.Methods: Telomerase activity and the p53 gene mutation were detected in 46 case of cardiac cancer, peri-cancerous and 30 case of normal mucosa by TRAP-ELISA and PCR-SSCP. Results: The rate of expression of telomerase activity in cardiac cancer, peri-cancerous and normal mucosa were 82.61％ (38/46), 43.48％ (20/46) and 13.33％ (4/30) respectively. The rate of Exon5→8 of p53 gene mutation were 39.13％ (18/46), 4.35％ (2/46) and 0.00％ respectively. There was significant differ ence between group cancer and without cancer (P ＜ 0.01). Mean of (A) value of telomerase is 1.89 ± 0.41 in cancer group and were 1.49 ± 0.43, 0.54 ± 0.45 respectively in peri-canvcerous and normal mucosa, there were significant differences in cancer group and group of without cancer (P ＜ 0.05). The rate of p53 gene mutations in group of expression of telomerase activity was 44.74％ (17/38), and 12.50％ (1/8) in without expression of telomerase activity. There were significant differences between the two groups. Conclusion: The rate of expression of telomerase activity and mean of (A) value of telomerase in cardiac cancer were obviously higher than without cancer, which indicating telomerase activity was closely related with the occurrence of cardiac cancer. P53 gene mutation in cardiac cancer were higher than the tissue of without cancer, and the rate of p53 gene mutation in telomerase activity were obviously higher than the group of without cancer. This shows the p53 gene mutation can loss of function of suppressing cancer and prompt telomerase activity and cause the cardiac cancer.     

p53基因突变对非小细胞肺癌TSG101/MDM2信号通路的影响

目的探讨p53基因突变在肺癌中对TSG101/MDM2信号通路影响的临床病理学意义。方法采用免疫组织化学方法检测185例肺癌组织标本中TSG101、MDM2及p53的表达,用聚合酶链反应单链构象多态性(Polymerase Chain Reaction ,single-strand conformation polymorphism, PCR-SSCP)分析法检测p53突变情况,以及Western blot检测TSG101在肺癌组织和正常肺组织中的表达。结果（1）肺癌组中p53蛋白的总阳性率为80.54%(149/185),PCR-SSCP检测结果显示总突变率为56.67%（17/30）,p53蛋白表达与病理分期、淋巴结转移有相关性（P<0.05）;TSG101蛋白的低表达率为58.92%(109/185),Western blot结果显示TSG101在癌组织中的表达明显低于对照组（P<0.05）,TSG101蛋白表达与病理分期、分化、淋巴结转移有相关性（P<0.05）;MDM2蛋白的过表达率为77.84%(144/185),MDM2蛋白表达与病理分期、淋巴结转移有相关性（P<0.05）。(2)在p53阳性的149例中TSG101阳性76例,MDM2阳性139例,在p53阴性的36例中TSG101阳性33例,MDM2阳性5例。p53与TSG101两者共表达率为41.08%,一致性为42.70%。p53与MDM2两者共表达率为75.14%,一致性为91.89%。结论（1）p53/MDM2上调与TSG101表达下调肺癌的发生及生物学行为有关。(2)当p53突变时, TSG101与MDM2的表达呈负相关关系。     

小细胞肺癌组织中p53基因改变的研究

为探讨小细胞肺癌（ＳＣＬＣ）发生的分子机制，应用免疫组化和聚合酶链反应—单链构象多态性分析的方法，对１４例ＳＣＬＣ组织进行ｐ５３基因突变研究。结果显示，有９例出现ｐ５３蛋白阳性，阳性率为６４．３％（９／１４）。ｐ５３基因第５，６，７，８外显子突变率分别为２１．４％（３／１４），１４．３％（２／１４），１４．３％（２／１４），７．１％（１／１４），总突变率为５７．１％（８／１４）。结果表明，ＳＣＬＣ组织中存在较高的ｐ５３基因突变率，故ｐ５３基因可能是人类肺癌发生的关键基因。     

肺癌病人痰液标本p53基因突变临床流行病学分析

[目的]探讨痰液标本p53基因突变检测用于肺癌高危人群筛查和肺癌早期诊断方面的意义。[方法]应用PCR鄄SSCP对63例肺癌患者和30例肺良性疾病的肺组织和痰液细胞中p53基因5～8外显子的突变进行了检测,并采用临床流行病学的方法进行分析。[结果]肺癌病人组肺癌组织中p53基因突变率为49.2%(31/63),对照组组织中突变率为3.3%(1/30),两组差别有统计学意义(P<0.001)。肺癌组痰液标本中p53突变率为23.8%(15/63);肺良性疾病患者痰液中未发现p53基因突变。以痰液标本p53基因突变为诊断指标,诊断的敏感度为45.2%,特异度为96.8%,标化阳性预告值为93.5%,标化阴性预告值为63.9%,标化一致性为71.0%。[结论]检测痰液中p53基因突变能间接反映其在肺组织中的改变,该方法可作为肺癌高危人群筛查以及肺癌诊断的无创性手段之一。     

非小细胞肺癌基因突变量与PD1单抗疗效关系的分析

目的:探索非小细胞肺癌基因突变量与PD1单抗疗效关系。方法:回顾性分析应用PD1单抗免疫治疗肿瘤患者,筛选其中非小细胞肺癌,入组患者须行基因突变检测,剔除其中合并EGFR、ALk等驱动基因突变患者;分析基因突变数量是否与免疫治疗疗效有关,同时分析对于是否带有基因突变,两组患者有效率、无进展生存等方面的差异。结果:对于非小细胞肺癌患者,是否带有非驱动基因突变,对于应用PD1单抗免疫治疗疗效,两组未见统计学差异,进一步分析显示,对于带有基因突变非小细胞肺癌患者,基因突变数量与PD1免疫治疗疗效关系,结果提示,多基因突变患者疗效（有效率50%）有优于单基因突变患者疗效（有效率29%）的趋势,但统计分析显示,多基因突变患者疗效并不优于单基因突变患者,且未见统计学差异（P=0.576）。结论:对于非小细胞肺癌患者,带有多基因突变患者的疗效有优于单基因突变患者疗效的趋势,或许更可能从免疫治疗中获益。但结果有待进一步多中心的临床研究证实。     

K-ras and p53 mutations are an independent unfavourable prognostic indicator in patients with non-small-cell lung cancer.

We examined 159 consecutive cases of non-small-cell lung cancer (NSCLC) for a mutation at codon 12 of the K-ras gene and for a mutation of the p53 gene occurring in exons 5-8. Eleven (6.9%) had mutations of the K-ras (ras+) and 57 (35.8%) had mutations of the p53 (p53+). There were 95 cases (59.7%) with ras- p53-, seven cases (4.4%) with ras+/p53-, 53 cases (33.3%) with ras-/p53+ and four cases (2.5%) with ras+/p53+. The ras+ group had a worse prognosis than the ras group in all cases and in 107 early-stage cases (stage I-II, P<0.05). The p53+ group had a worse prognosis in 107 early-stage cases (P<0.01), but there was no statistically significant difference when 52 advanced-stage cases (stage III-IV) or all patients were considered. Both ras and p53 mutations were unfavourable prognostic factors in 94 cases with adenocarcinoma, but there was no statistical significance in 57 cases with squamous cell carcinoma. According to Cox''s model, the pathological stage, ras mutation and p53 mutation were found to be independent prognostic factors. Our results suggest that ras and p53 mutations were independent unfavourable prognostic markers especially in the early stage of NSCLC or in adenocarcinoma.     

Comparison of p53 mutations between adenocarcinoma and squamous cell carcinoma of the lung: unique spectra involving G to A transitions and G to T transversions in both histologic types

The p53 gene is frequently mutated in lung tumors, and mutations may be caused by both polycyclic aromatic hydrocarbons (PAHs) and nitrosamines found in tobacco smoke. The two major forms of lung cancer, adenocarcinoma (AC) and squamous cell carcinoma (SCC), are known to differ in the proportion of tumors exhibiting p53 mutation, and may also differ in the mutational spectra produced. Previous studies comparing p53 mutational spectra between AC and SCC of the lung have been limited by small sample size. We examined p53 mutations in exons 5-8 in 202 cases of AC and 82 cases of SCC from smoking lung cancer patients in the Western Pennsylvania region. The percent of cases with p53 mutation was significantly lower in ACs (40/202, 20%) compared to SCCs (29/82, 35%, P=0.006). The proportion of mutations present that were G to T transversions was not significantly different between the two tumor types (52% of p53 mutations in AC compared to 32% in SCC). G to A transitions either did not differ in frequency in the two types of lung cancer (20% of mutations in AC and 24% of mutations in SCC). A distinct spectrum was observed, however, in the p53 mutation pattern in the two types of lung cancer. ACs showed a strong preference for a mutational hotspot at codons 248 and 249, while squamous cell tumors showed mutational events spread throughout exons 5-8, with a preference for codon 267. Mutations at codon 267 in SCC were all C to T transitions that occurred at CpG sites. Both tumor types demonstrated preferential mutation of the non-transcribed strand (100% of all G to T transversions and 55% of the G to A transitions). These results suggest that p53 mutations in both types of lung tumors may arise from adduction by both PAHs and nitrosamines. Mutations arising in ACs appear selectively in regions of p53 that produce more rigid proteins, suggesting a drastic change in p53 function is needed to result in ACs, while less constrained changes in p53 function can result in SCCs. Mutation in p53 was not found to be related to patient survival in this group of patients, while tumor size and degree of differentiation were poor survival predictors.     

DETECTION OF p53 GENE MUTATION OF BRONCHOSCOPIC SAMPLIES IN THE PATIENTS SUSPECTED TO LUNG CANCER

As other malignant tumors, lung cancer is a disease with alteration of genetic materials. P53 gene mutation is the most common and the early genetic alteration in lung cancer. Previous studies about the p53 gene mutation in lung cancer were mainly focused on the resected tumor tissues, it was not useful to the early diagnosis of lung cancer. In this paper, point mutation of the exon 5 to 8 of p53 gene were detected using PCR-single strand conformation polymorphism(PCR-SSCP) in bronchoscopi…