晚期非小细胞肺癌中淋巴结转移与EGFR突变的相关性及对患者预后的影响

摘要

Objective To explore the correlation between lymph node metastasis and epidermal growth factor recep-tor (EGFR) mutation and its predictive value on overall survival in patients with advanced non-small cell carcinoma (NSCLC). Method A total of 1358 cases of advanced NSCLC patients were retrospectively analyzed. Kaplan-Meier sur-vival curve was used to analyze overall survival (OS) and Log-rank test was used to calculate P values. Result The N stage were statistically correlated with smoking history, EGFR status and M stage (P<0.05). Negative lymph node metas-tasis or hilar lymph node metastasis (N0-1) was mostly observed in nonsmoker with EGFR mutation or at the stage of M1a. There was remarkably prolonged OS in the group of N0-1 than N2-3 as shown in Kaplan-Meier survival curve (P<0.001). Based on EGFR mutational status stratification, the best and worst prognosis were observed in N0-1/EGFR+ group and N2-3/EGFR-group, respectively, however, there was no significant difference in survival time between the N0-1/EGFR-and N2-3/EGFR+ group (P=0.642). Based on M stage stratification, N0-1/M1a group showed the best prognosis, while the N2-3/M1b group demonstrated the worst, however, there was no significant difference in regard of survival time between pa-tients of N0-1/M1b or N2-3/M1a (P=0.450). Conclusion There was significant correlation between N stage and EGFR muta-tional status in advanced NSCLC patients. Those with an early N stage (N0-1) seem to have a better overall survival than those with advanced ones (N2-3). Meanwhile, EGFR status and M stage could also affect the prognosis of patients with lymph node metastasis.%目的 探索晚期非小细胞肺癌中淋巴结转移与表皮生长因子受体(EGFR)突变状态的相关性及对患者总生存的预测价值.方法 回顾性分析1358例晚期非小细胞肺癌患者的临床病理资料和随访资料,Kaplan-Meier法进行疾病总生存率(OS)分析,并采用Log-rank检验进行比较.结果 吸烟与不吸烟患者、EGFR突变型与EGFR野生型患者、M1a与M1b患者的N分期间,差异均有统计学意义(P﹤0.05);淋巴结转移阴性或仅有肺门淋巴结转移患者(N0~1)多为不吸烟、EGFR突变型及M1a患者.Kaplan-Meier生存分析结果 显示,N0~1组患者总生存时间明显长于N2~3组患者(P﹤0.001).按EGFR因素分层分析显示,N0~1/EGFR突变组患者的预后最好,N2~3/EGFR野生组患者的预后最差,而N0~1/EGFR野生组与N2~3/EGFR突变组患者的生存时间比较,差异无统计学意义(P=0.642);按M分期分层分析显示,N0~1/M1a组患者的预后最好,N2~3/M1b组患者的预后最差,而N0~1/M1b组与N2~3/M1a组患者的生存时间比较,差异无统计学意义(P=0.450).结论 非小细胞肺癌中淋巴结分期与EGFR突变状态有关,N0~1期患者预后明显优于N2~3期患者,同时EGFR状态及M分期可进一步影响不同淋巴结分期患者的预后.