论文部分内容阅读
目的经支气管镜活检小量标本检测表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变,指导临床靶向治疗。方法ⅢB~Ⅳ期女性肺腺癌患者56例,行内镜下气管腔内瘤组织活检或经支气管针吸活检术活检纵隔、肺门淋巴结,共收集标本64例,其中内镜下支气管内单纯组织活检标本20例,单纯淋巴结穿刺活检标本(TBNA)28例,支气管腔内组织及纵隔、肺门淋巴结均活检的标本8例。明确诊断肺腺癌后行EGFR基因检测,分别检测19、21外显子突变,将标本分为支气管腔内转移组和淋巴结转移组,统计分析两组外显子突变情况及患者靶向治疗临床疗效。结果 19外显子突变在支气管腔内转移组阳性率较高(χ2=4.304,P=0.038),21外显子突变在在淋巴结转移组阳性率较高(χ2=18.727,P=0.000)。共24例纳入临床疗效评估,其中支气管腔内转移患者10例(19外显子突变8例,21外显子突变2例),疾病控制率90%(9/10),中位无进展生存期14.8个月;淋巴结转移患者14例(19外显子突变3例,21外显子突变11例),疾病控制率78.57%(11/14),中位无进展生存期9.2个月,两组疾病控制率差异无统计学意义(P>0.05),中位无进展生存期差异有统计学意义(χ2=4.134,P=0.042)。结论女性晚期肺腺癌EGFR外显子突变与不同转移形式有一定的关系,19外显子突变易出现于支气管内转移,21外显子突变易出现于淋巴结转移;支气管内转移的患者靶向治疗效果好于淋巴结转移的患者。
Objective To detect the mutation of epidermal growth factor receptor (EGFR) gene by bronchoscopic biopsy and to guide clinical targeted therapy. Methods Sixty-six patients with stage ⅢB-Ⅳ female lung adenocarcinoma underwent endoscopic biopsy of the endobronchial tumor or biopsy of the mediastinum and hilar lymph nodes by bronchial needle aspiration. A total of 64 specimens were collected, of which endobronchial simple bronchial endoscopy Tissue biopsy specimens in 20 cases, simple lymph node biopsy specimens (TBNA) in 28 cases, bronchial tissue and mediastinal, hilar lymph node biopsy specimens in 8 cases. A clear diagnosis of lung adenocarcinoma after EGFR gene detection, detection of 19,21 exon mutations, the specimens were divided into bronchial cavity and lymph node metastasis group, statistical analysis of two groups of exon mutations and patients targeted therapy clinical Efficacy. Results 19 The positive rate of exon mutation in bronchial lumen metastasis group was higher (χ2 = 4.304, P = 0.038). The positive rate of exon 21 mutation in lymph node metastasis group was higher (χ2 = 18.727, P = 0.000). A total of 24 cases were included in the evaluation of clinical efficacy, including 10 patients with endobronchial metastases (19 exon 8, 21 exon 21), disease control rate 90% (9/10), median progression-free survival 14.8 months; 14 cases of lymph node metastasis (19 exon mutations in 3 cases, 21 exon mutations in 11 cases), the disease control rate was 78.57% (11/14), the median progression-free survival of 9.2 months, two There was no significant difference in disease control rate between the two groups (P> 0.05). The median progression-free survival was statistically significant (χ2 = 4.134, P = 0.042). Conclusion The exon mutation of EGFR in patients with advanced lung adenocarcinoma has certain relationship with different metastatic forms. 19 Exon mutations are easy to occur in bronchial transfer and 21 exon mutations in lymph node metastasis. The target of bronchial metastasis The treatment is better than lymph node metastasis patients.