本文選題：晚期非小細(xì)胞肺癌 + EGFR基因突變��； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：第一部分 EGFR基因突變與晚期非小細(xì)胞肺癌患者臨床病理特征的相關(guān)性研究目的:EGFR基因突變與晚期非小細(xì)胞肺癌(NSCLC)患者臨床病理特征的相關(guān)性。方法:選用2014年1月-2015年12月在廣西壯族自治區(qū)人民醫(yī)院收治的經(jīng)病理學(xué)診斷為NSCLC且臨床分期(IIIB/IV期)325例患者作為研究對(duì)象,收集病理學(xué)組織,采用ARMS法檢測(cè)EGFR基因突變,分析EGFR基因突變與晚期NSCLC患者臨床及病理特征的相關(guān)性。結(jié)果:325例晚期NSCLC中,EGFR基因總突變率37.5%(122/325)。其中18、19、20、21外顯子分別占總突變的0.8%(1/122)、46.7%(57/122)、5.8%(8/122)、41.9%(52/122)。19、21外顯子兩者占總突變的88.6%。其男性206例,突變型56例,突變率27%(56/206),女性119例,突變型66例,突變率55.4%(66/119),女性的突變率明顯高于男性(P=0.000);非腺癌61例,基因突變型9例,突變率14.8%(9/61),腺癌264例,基因突變型113例,突變率42.8%(113/264),腺癌突變率明顯非腺癌(P=0.000);無(wú)吸煙214例,突變型97例,突變率45.3%(97/214),吸煙111例,突變型25例,突變率22.5%(25/111);中低分化110例,突變型22例,突變率20%(22/110),高分化215例,突變型110例,突變率46.5%(110/215),高分化突變率明顯高于中低分化(P=0.000);兩組差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:晚期NSCLC的EGFR基因突變主要發(fā)生在18、19、20、21外顯子,其最常見19號(hào)外顯子,其次21號(hào)外顯子(L858R),19、21外顯子兩者占總突變的88.6%。EGFR基因突變最常見于女性、不吸煙、腺癌、分化程度較高的NSCLC患者�；颊叩男詣e、吸煙史、病理類型、腫瘤分化程度是預(yù)測(cè)EGFR基因突變的獨(dú)立因素。第二部分 晚期非小細(xì)胞肺癌EGFR基因不同狀態(tài)預(yù)后以及影響因素目的:分析我院晚期非小細(xì)胞肺癌不同治療模式中位無(wú)疾病病進(jìn)展(mPFS)及中位總生存期(mOS)、客觀緩解率(ORR)、疾病控制率(DCR)、靶向藥物及化療藥物不良反應(yīng);分析我院晚期非小細(xì)胞肺癌EGFR基因不同狀態(tài)治療模式總生存期(mOS)及無(wú)病進(jìn)展生存期(mPFS)的獨(dú)立預(yù)后因素。方法:本研究為回顧性隊(duì)列研究,收集2014年1月到2015年12月廣西壯族自治區(qū)人民醫(yī)院行EGFR基因檢測(cè)的經(jīng)治122例為晚期NSCLC患者的住院病案資料和電話隨訪;用SPSS21.0軟件分析中位PFS、中位OS、客觀緩解率(objective response rate,ORR)、疾病進(jìn)展率(disease control rate,DCR)及不良反應(yīng),行單因素、多因素生存分析。結(jié)果:1.122例行EGFR基因檢測(cè)IIIB/IV期NSCLC患者中位OS 12.2個(gè)月和中位PFS 6.6個(gè)月。2.EGFR基因突變組和EGFR基因野生組中位PFS分為8.76個(gè)和5.1個(gè)月,EGFR基因突變組和EGFR基因野生組中位OS分別為14.2個(gè)月和10.9個(gè)月,EGFR突變型的客觀緩解率47.4%,疾病控制率81.3%;EGFR野生型的客觀緩解率31.5%,疾病控制率61.9%;EGFR-TKI藥物的不良反應(yīng):皮疹和腹瀉;化療藥物的不良反應(yīng):骨髓抑制和消化道反應(yīng)。3.Kaplan-Meier單因素分析:ECOG評(píng)分、EGFR基因不同狀態(tài)治療方式存在生存時(shí)間的差異。4.COX回歸多因素分析,影響晚期非小細(xì)胞肺癌獨(dú)立預(yù)后因素有:ECOG評(píng)分、EGFR基因不同狀態(tài)治療方式。結(jié)論:1.122例行EGFR基因檢測(cè)IIIB/IV期NSCLC患者中位OS 12.2個(gè)月和中位PFS 6.6個(gè)月。2.EGFR突變型比EGFR野生型預(yù)后好。3.影響晚期非小細(xì)胞肺癌獨(dú)立預(yù)后因素:ECOG評(píng)分、EGFR基因不同狀態(tài)治療。
[Abstract]:Part 1 Correlation of the EGFR gene mutation with the clinicopathological features of patients with advanced non-small cell lung cancer. Objective: the correlation between the EGFR gene mutation and the clinicopathological features of patients with advanced non-small cell lung cancer (NSCLC). Methods: the pathological diagnosis of NSCL in the people's Hospital in the Guangxi Zhuang Autonomous Region, January 2014, in December, was NSCL C and clinical stage (IIIB/IV phase) 325 patients were used as the research object, collecting pathological tissue, using ARMS method to detect the mutation of EGFR gene, and analyzing the correlation between the EGFR gene mutation and the clinical and pathological features of the late NSCLC patients. Results: the total mutation rate of EGFR gene was 37.5% (122/325) in the 325 cases of late NSCLC. Among them, the 18,19,20,21 exons accounted for the total process, respectively. 0.8% (1/122), 46.7% (57/122), 5.8% (8/122), 41.9% (52/122).19,21 exons accounted for 206 cases of total mutation of 88.6%., mutation type 56 cases, mutation rate 27% (56/206), female 119 cases, mutation 66 cases, 55.4% (66/119) mutation rate, women's mutation rate was significantly higher than that of male (P=0.000); non adenocarcinoma 61 cases, gene mutation 9 cases, 14.8% mutation rate 14.8% (9) /61) adenocarcinoma 264 cases, mutation type 113 cases, mutation rate 42.8% (113/264), adenocarcinoma mutation rate is obviously non adenocarcinoma (P=0.000); no smoking 214 cases, mutation type 97 cases, mutation rate 45.3% (97/214), smoking 111 cases, mutation 25 cases, mutation rate 22.5% (25/111); middle and low differentiation 110 cases, mutation rate 20% (22/110), high differentiation 215 cases, mutant 215 cases, abrupt mutation type 110 cases, abrupt The mutation rate was 46.5% (110/215), and the high differentiation mutation rate was significantly higher than that of the middle and low differentiation (P=0.000). The difference between the two groups was statistically significant (P0.05). Conclusion: the EGFR gene mutation of late NSCLC mainly occurred in exon 19, the most common exon 19, and the second exon 21 exon (L858R), and the 88.6%.EGFR gene mutation of the exon 19,21 of 19,21. Most common in women, non smoking, adenocarcinoma, and highly differentiated NSCLC patients. The sex, smoking history, pathological type, and tumor differentiation are independent factors for predicting EGFR gene mutation. Second the prognosis of different state of EGFR gene in late non small cell lung cancer and the influence factors are to analyze the difference of non small cell lung cancer in our hospital. The progression of disease free disease (mPFS) and median total survival (mOS), objective remission rate (ORR), disease control rate (DCR), targeted drugs and adverse reactions to chemotherapeutic drugs, and the independent prognostic factors of the total survival period (mOS) and the progression free survival (mPFS) of the EGFR gene therapy mode in advanced non-small cell lung cancer in our hospital. In this study, a retrospective cohort study was conducted to collect data and telephone follow-up data of 122 patients with advanced NSCLC from January 2014 to December 2015 in the people's Hospital of the Guangxi Zhuang Autonomous Region, the Guangxi Zhuang Autonomous Region people's hospital. The SPSS21.0 software was used to analyze the median PFS, OS, the objective remission rate (objective response rate, ORR), and the rate of disease progression (diseas). E control rate, DCR) and adverse reactions, single factor and multifactor survival analysis. Results: 1.122 cases of EGFR gene detection in IIIB/IV phase NSCLC patients were divided into 8.76 and 5.1 months, 8.76 and 5.1 months in the middle PFS 6.6 month.2.EGFR gene mutation group and the EGFR gene wild group. For 14.2 months and 10.9 months, the objective remission rate of the EGFR mutant was 47.4%, the disease control rate was 81.3%, the objective remission rate of the EGFR wild type was 31.5%, the disease control rate was 61.9%; the adverse reaction of the EGFR-TKI drug: rash and diarrhea; the adverse reaction of the chemotherapeutic drugs: the single factor analysis of the myelosuppression and the dehydrated pathway.3.Kaplan-Meier: the ECOG score, the EGFR base The independent prognostic factors of advanced non-small cell lung cancer were.4.COX regression and multiple factor analysis because of the difference in the survival time of different states of treatment. The independent prognostic factors of advanced non-small cell lung cancer were: ECOG score and different state of EGFR gene therapy. Conclusion: 1.122 cases of EGFR gene detection in IIIB/IV stage NSCLC patients with OS 12.2 months and median PFS 6.6 months.2.EGFR process variant are compared to EGFR. The prognosis of the wild type is good..3. affects the independent prognostic factors of advanced non-small cell lung cancer: ECOG score and EGFR gene treatment.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 孔蘊(yùn)源;呂小林;江梅;聶益軍;張長(zhǎng)林;萬(wàn)臘根;;江西地區(qū)非小細(xì)胞肺癌EGFR基因突變分析[J];實(shí)驗(yàn)與檢驗(yàn)醫(yī)學(xué);2016年05期

2 馬玲;張琰;單莉;韓志剛;;維吾爾族晚期非小細(xì)胞肺癌患者EGFR、KRAS基因突變狀態(tài)及其與TKI靶向治療效果的關(guān)系[J];山東醫(yī)藥;2016年31期

3 梁穎;林勇平;徐韞健;王慧;宋金龍;劉忠民;;非小細(xì)胞肺癌EGFR基因突變的異質(zhì)性[J];熱帶醫(yī)學(xué)雜志;2015年12期

4 楊寧;郭妹;宋玉蘭;李美霞;蒲曉宇;;430例中國(guó)非小細(xì)胞肺癌患者EGFR、KRAS、BRAF和PIK3CA基因突變狀態(tài)及其臨床意義[J];中國(guó)腫瘤生物治療雜志;2015年06期

5 趙瑾;田俏梅;黃玉梅;熊銀鷹;龔倩;吳白平;;湖南地區(qū)238例非小細(xì)胞肺癌EGFR基因突變狀態(tài)分析[J];腫瘤藥學(xué);2014年03期

6 唐艷萍;張力圖;譚曉玉;蔡政民;利基林;;廣西南寧地區(qū)非小細(xì)胞肺癌EGFR基因突變分析[J];現(xiàn)代腫瘤醫(yī)學(xué);2014年05期

7 汪華;張?jiān)?耿熠;;晚期非小細(xì)胞肺癌化療預(yù)后因素的COX回歸分析[J];實(shí)用癌癥雜志;2014年02期

8 廉政君;黃建國(guó);;晚期非小細(xì)胞肺癌預(yù)后相關(guān)因素分析[J];現(xiàn)代腫瘤醫(yī)學(xué);2014年01期

9 董丹丹;唐源;鄒艷;李芳華;曹梅;劉衛(wèi)平;;四川地區(qū)肺腺癌中EGFR基因19、21外顯子突變研究[J];臨床與實(shí)驗(yàn)病理學(xué)雜志;2011年12期

10 孫孟紅;楊飛;沈磊;張玲;陳穎;蔡旭;朱曉麗;周曉燕;;非小細(xì)胞肺癌中表皮生長(zhǎng)因子受體基因突變直接測(cè)序分析及其與臨床病理特征的相關(guān)性[J];中華病理學(xué)雜志;2011年10期

相關(guān)博士學(xué)位論文 前1條

1 李峻嶺;晚期非小細(xì)胞肺癌臨床預(yù)后因素及治療[D];北京協(xié)和醫(yī)學(xué)院;2012年

，

本文編號(hào)：1944823