晚期肺腺癌EMT和EGFR突变状态的关系及其对吉非替尼治疗疗效的影响

目的：探讨晚期肺腺癌上皮间质转化（EMT）与表皮生长因子（EGFR）突变的关系及其对吉非替尼治疗敏感性的关系。方法通过检测78例晚期肺腺癌EGFR突变情况和E-cadherin/β-catenin表达情况，对EGFR突变的晚期肺腺癌患者一线使用吉非替尼，EGFR未突变的晚期肺腺癌一线化疗失败后二线使用吉非替尼治疗，观察吉非替尼治疗的疗效和无进展生存时间（PFS）。结果晚期肺腺癌EGFR突变患者E-cadherin表达高于EGFR未突变患者。EGFR突变且E-cadherin/β-catenin阳性表达者疾病控制率（DCR）略高于异常表达者，虽差异无统计学意义，但EGFR突变同时E-cadherin/β-catenin阳性表达者显示了更长的PFS。EGFR未突变的晚期肺腺癌二线吉非替尼治疗患者临床获益率低。结论晚期肺腺癌患者EGFR突变者常伴随E-cadherin高表达，同时存在EG-FR突变和E-cadherin/β-catenin高表达者显示更长的PFS；不建议EGFR未突变的晚期肺腺癌病例二线使用吉非替尼。

EMT and EGFR mutations in advanced lung adenocarcinoma and the impact on efficacy of gefitinib therapy

Objective To investigate the correlation between epithelial-to-mesenchymal transition (EMT) and EGFR mutation, and the impact on the sensitivity of gefitinib in advanced lung adenocarcinoma. Method 78 cases of advanced lung adenocarcinoma were enrolled in the study, of which the EGFR mutations and E-cadherin/β-catenin expression were detected. Gefitinib was used in patients with EGFR mutation as first-line treatment, while used as second-line thera-py in those with EGFR wild type and failed first-line treatment, then the efficacy of gefitinib and progression-free surviv-al (PFS) were observed. Result The E-cadherin expression was higher in patients with EGFR mutation than those with EGFR wild type. The disease control rate (DCR) was slightly higher in patients with EGFR mutation, and E-cadherin/β-catenin positive expression than those with abnormal expression, suggesting a longer but insignificant PFS benefit. Gefi-tinib therapy as second-line treatment in advanced lung adenocarcinoma patients with EGFR wild type showed low bene-fit rate. Conclusion EGFR mutations are often associated with high expression of E-cadherin in advanced lung adenocar-cinoma. The PFS is longer in patients with both EGFR mutation and positive expression of E-cadherin/β-catenin. It is not recommended to use gefitinib as second-line treatment in advanced lung adenocarcinoma patients with EGFR wild type.