放疗、化疗及放化疗治疗非小细胞肺癌对 EGFR 基因突变状态的影响

目的：研究放疗、化疗和放化疗三种临床非小细胞肺癌（non - small cell lung cancer，NSCLC）治疗方式对 EGFR 基因突变状态的影响。方法：采用 ARMS 血浆 EGFR 基因突变分析方法，分别对393例晚期NSCLC 患者放疗、化疗和放化疗治疗前、治疗后获得的外周血标本进行 EGFR 基因突变检测。结果：放疗、化疗和放化疗三种治疗手段均影响 EGFR 基因突变状态。单纯放疗组放疗前的 EGFR 基因突变率为31.78%，放疗后的 EGFR 基因突变率为20.16%，放疗显著影响 EGFR 基因突变状态（P <0.016）。单纯化疗组化疗前的 EGFR 基因突变率为34.56%，化疗后的 EGFR 基因突变率为22.06%，化疗显著影响 EGFR 基因突变状态（P <0.013）。放化疗组放化疗前的 EGFR 基因突变率为33.59%，放化疗后 EGFR 基因突变率为17.19%，放化疗显著影响 EGFR 基因突变状态（P <0.001）。结论：放疗、化疗和放化疗均可降低 NSCLC 患者外周血中EGFR 基因突变率，提示放疗、化疗和放化疗治疗会对外周血中 EGFR 基因突变状态发生影响，采用外周血检测 NSCLC 的 EGFR 基因状态能够在治疗过程中动态观察患者的变化，进一步指导临床治疗。

Influence of radiotherapy,chemotherapy and radiochemotherapy on EGFR mutation sta-tus in patients with non - small cell lung cancer

Objective:To study the influence of radiotherapy,concurrent radiochemotherapy and chemotherapy on status of EGFR gene mutation in patients with non - small cell lung cancer. Methods:Using plasma amplification re-fractory mutation system analysis method to detect EGFR gene mutation in peripheral blood tumor cells DNA,EGFR gene mutation status was detected in plasma samples obtaining from 393 cases advanced non - small cell lung cancer (NSCLC)patients before and after radiotherapy,concurrent radiochemotherapy and chemotherapy. Results:The ra-diotherapy,concurrent radiochemotherapy and chemotherapy make influence on the EGFR gene mutation status in plasma samples. For the chemotherapy group,the frequency of EGFR gene mutation was 34. 56% before chemotherapy compared as 22. 06% after chemotherapy. The chemotherapy significantly influenced the frequency of EGFR gene mu-tation(P < 0. 013). For the radiotherapy group,the frequency of EGFR gene mutation was 31. 78% before radiothera-py compared as 20. 16% after radiotherapy. The radiotherapy significantly influenced the frequency of EGFR gene mutation(P < 0. 016). For the concurrent radiochemotherapy group,the frequency of EGFR gene mutation was 33. 59% before treatment compared as 17. 19% after treatment. The concurrent radiochemotherapy significantly make influence on the frequency of EGFR gene mutation(P < 0. 001). Conclusion:Radiotherapy,concurrent radiochemo-therapy and chemotherapy could decrease the frequency of EGFR gene mutation. The results suggest that radiothera-py,concurrent radiotherapy with chemotherapy and chemotherapy could make influence on EGFR gene status. It was good way for the non - small cell lung cancer patients to monitor EGFR gene mutation status by peripheral blood tumor cells DNA to guide the clinical practice.