EGFR 外显子19缺失突变在肺腺癌、鳞癌中的表达及临床意义

摘要

目的：探讨EGFR 19缺失突变在非小细胞肺癌（ NSCLC）组织中的表达及与临床病理特点的关系，为NSCLC TKI个体化靶向治疗提供临床依据。方法：收集第四军医大学唐都医院胸腔外科2010年9月至2013年11月手术切除经ARMS法检测为19-Del的NSCLC标本125例。免疫组化检测EGFR 19-Del表达，半定量分析其与临床病理特点的关系。结果：19-Del阳性着色呈棕黄色或深黄色颗粒样，主要定位在细胞膜上。鳞癌和腺癌相比，19-Del的表达强度无统计学差异（ P＝0.480）。19-Del在肺腺癌病理分级、TNM分期、原发肿瘤大小、淋巴结转移状态以及肿瘤位置间表达差异显著（P值均<0.05），而在鳞癌组间差异无统计学意义（P值均>0.05）。另外，19-Del表达在性别、年龄、吸烟史组中差异性不显著（P值均>0.05）。19-Del的阳性程度与ARMS法RT-PCR中Ct值之间有较强负相关性（ P＝0.000，rs ＝-0.662）。结论：19-Del表达强度与NSCLC的病理分级、TNM分期、淋巴结转移状态等相关，提示19-Del很可能具有促进肺癌发生发展的作用。免疫组化方法检测EGFR 19缺失突变结果与ARMS法一致性较好，方法可行。%Objective:In order to provide clinical basis for the individual target-therapy of NSCLC TKI,the ex-pression of EGFR exon 19 deletion in NSCLC tissues and the correlation with clinicopathological features were investi-gated. Methods:NSCLC samples with EGFR exon 19 deletion were collected,which were selected by ARMS in Tang-du Hospital of Fourth Military Medical University from September 2010 to November 2013,and the expression of 19-Del was detected by immunochemistry in NSCLC,then the relevance of 19-Del with clinicopathological features was analyzed using semi-quantitatively. Results:The expression of EGFR with exon 19 deletion was mainly located in cell membrane and was stained to yellow or deep yellow. There was no significant differences of 19-Del expression between the squamous carcinoma group and the adenocarcinoma group(P=0. 480). There were significant differ-ences of 19-Del among the different pathological grades,TNM stages,the tumor size,lymph node metastasis status and tumor locationgroups in lung adenocarcinoma(P<0. 05),while there were no statistical differences about the features of TNM stage et al. in squamous carcinoma(P>0. 05). Furthermore,the difference for 19-Del expression in the gender,age and smoking history groups were not significant(P>0. 05). And the correlation between the posi-tive degree of 19-Del and Ct value in ARMS was strong negative(P=0. 000,rs = -0. 662). Conclusion:There were good correlations of 19 -Del with histological grades,TNM stages and lymph nodemetastasis status,prompting that the 19-Del mutation may affect tumorgenesis and progression. The detecting result of 19-Del is in good consis-tency with the ARMS which means that the immunochemistrymethod is feasible.