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目的:探讨EGFR和KRAS突变在未经系统酪氨酸激酶抑制剂(tyrosine kinases inhibitors,TKIs)治疗的非小细胞肺癌(non-small cell lung cancer,NSCLC)患者中的预后预测价值。方法:收集56例未经过系统TKIs治疗的NSCLC患者手术组织样本,通过液相芯片技术进行EGFR与KRAS突变检测,随访2.9~30.0个月,收集患者的临床资料与死亡资料,分析患者2年生存率。结果:56例NSCL组织中,19例(33.9%)存在EGFR突变,其中9例为E19突变,10例为E21突变;8例(14.3%)存在KRAS突变,其中7例为E2突变,1例为E3突变。单因素分析显示,携带KRAS突变的患者2年生存率低于KRAS无突变患者,P=0.023 2;而EGFR突变的患者2年生存率高于EGFR无突变患者,但差异无统计学意义,P=0.060 5。双基因分析显示,3组NSCLC患者的2年生存率差异有统计学意义,P=0.033 9。组间比较显示,EGFR E19/E21突变组2年生存率优于KRAS E2/E3突变组,校正P=0.031 5,EGFR E19/E21突变组与野生型组、KRAS E2/E3突变组与野生型组的2年生存率均差异无统计学意义,校正P值分别为0.506 0和0.628 6。多因素Cox回归分析显示,KRAS突变与KRAS和EGFR综合突变情况是NSCLC患者2年生存率的独立预测因子。其中,KRAS突变/KRAS无突变,P=0.037;EGFR E19/E21突变组/KRAS E2/E3突变组,P=0.039。结论:KRAS突变与KRAS和EGFR综合突变情况是未经系统TKIs治疗NSCLC患者生存的独立预测因子,对患者预后具有指示意义。
Objective: To investigate the prognostic value of EGFR and KRAS mutations in non-small cell lung cancer (NSCLC) patients who have not been treated with tyrosine kinase inhibitors (TKIs). Methods: Tissue samples of 56 NSCLC patients without systemic TKIs were collected. The EGFR and KRAS mutations were detected by liquid-phase microarray. The patients were followed up for 2.9-30.0 months. The clinical data and death data were collected. The 2-year survival rate rate. Results: Of 56 NSCL tissues, EGFR mutations were found in 19 (33.9%) of them, of which 9 were E19 and 10 were E21 mutations. KRAS mutations were found in 8 (14.3%) of them, of which 7 were E2 mutations and 1 E3 mutation. Univariate analysis showed that the 2-year survival rate of patients with KRAS mutation was lower than that of patients without KRAS mutation (P = 0.023 2), while the 2-year survival rate of patients with EGFR mutation was higher than that without EGFR mutation, but the difference was not statistically significant = 0.060 5. Two-gene analysis showed that the 2-year survival rates of 3 NSCLC patients were significantly different (P = 0.0339). The two-year survival rate of EGFR E19 / E21 mutation group was higher than that of KRAS E2 / E3 mutation group, P = 0.031 5, EGFR E19 / E21 mutation group and wild type group, KRAS E2 / E3 mutation group and wild type There was no significant difference in 2-year survival rate between the two groups. The corrected P values were 0.506 0 and 0.628 6 respectively. Multivariate Cox regression analysis showed that the combination of KRAS mutation with KRAS and EGFR mutations was an independent predictor of 2-year survival in patients with NSCLC. Among them, KRAS mutation / KRAS had no mutation, P = 0.037; EGFR E19 / E21 mutation group / KRAS E2 / E3 mutation group, P = 0.039. CONCLUSIONS: The combination of KRAS mutation and KRAS and EGFR mutations is an independent predictor of survival in patients with NSCLC who have not undergone systemic TKIs, which is indicative of the prognosis of patients.