本文選題：肺癌　切入點(diǎn)：基因突變　出處：《浙江大學(xué)》2015年碩士論文

【摘要】：目的：明確CT引導(dǎo)下肺癌穿刺活檢EGFR及ALK基因的檢出率和陽性率,并分析臨床病理表現(xiàn)與基因突變的關(guān)系以及提高檢出率相關(guān)的因素。方法：收集浙江省腫瘤醫(yī)院2014年6月至2015年8月期間250例肺癌患者的臨床資料及其CT引導(dǎo)下穿刺活檢標(biāo)本。根據(jù)腫塊部位及其大小采取合適的穿刺針,其中細(xì)針穿刺50例,粗針200例。細(xì)針選用Cook 19G同軸半自動(dòng)活檢針或普利賽20G半自動(dòng)活檢針,粗針選用BioPince 17G同軸全自動(dòng)活檢針或普利塞18G、16G半自動(dòng)活檢針。運(yùn)用ScorPions ARMS檢測(cè)250例穿刺標(biāo)本的EGFR基因,使用VentanaALK(D5F3)免疫組化方法檢測(cè)250例穿刺標(biāo)本ALK基因的表達(dá)。結(jié)果：250例NSCLC患者的活檢標(biāo)本中,103例存在EGFR基因突變,突變率為41.2%；其中以第19外顯子缺失(44.7%)和第21外顯子L858R突變(39.8%)多見；250例標(biāo)本中共檢測(cè)到15例(6%)ALK融合基因。EGFR基因女性患者突變率明顯高于男性患者(62.1%,37.9%,P0.01,)；非吸煙患者的突變率明顯高于吸煙患者(56.2%,25%,P0.01,)；而年齡以及分期與基因突變無相關(guān)性。組織學(xué)類型中腺癌EGFR基因突變率(56.6%,P0.01)明顯高于鱗癌和其它類型肺癌。本研究沒有發(fā)現(xiàn)ALK基因表達(dá)與性別、年齡、病理分化程度等因素的相關(guān)性(P0.05)；15例ALK基因陽性者全部不吸煙,均為腺癌,Ⅳ期患者ALK基因的突變比非Ⅳ期患者明顯高(18.5%,1.8%,P0.01)。EGFR基因檢出率為83.2%(208/250),粗針活檢穿刺的檢出率高于細(xì)針(91%,52%,P0.01),陽性率也高于細(xì)針(45.5%,24%,P0.01),粗針穿刺檢出率高與粗針穿刺腫瘤細(xì)胞個(gè)數(shù)大于細(xì)針穿刺腫瘤細(xì)胞個(gè)數(shù)(P0.05)有關(guān),而與粗細(xì)針腫瘤細(xì)胞比例無關(guān)(P0.05),其中腫瘤細(xì)胞數(shù)目大于50者檢出率更高。ALK蛋白免疫組化檢測(cè)檢出率為87.2%,粗針活檢穿刺的檢出率高于細(xì)針(91%,72%,P0.01),但陽性率無差異(P0.05),粗針活檢穿刺的檢出率高低也與粗細(xì)針穿刺腫瘤細(xì)胞個(gè)數(shù)差異有關(guān)(P0.05),而與粗細(xì)針穿刺腫瘤細(xì)胞比例無關(guān)(P0.05)。結(jié)論：250例標(biāo)本中EGFR基因及ALK基因的檢出率分別為83.2%和87.2%,二者粗針活檢穿刺的檢出率均高于細(xì)針,但細(xì)針檢出率仍不低,對(duì)于有細(xì)針穿刺適應(yīng)癥的患者,細(xì)針穿刺仍是首選�；驒z出率的高低與腫瘤細(xì)胞個(gè)數(shù)有關(guān),而與腫瘤細(xì)胞比例無關(guān),腫瘤細(xì)胞數(shù)目大于50者檢出率更高。
[Abstract]:Objective: to determine the detection rate and positive rate of EGFR and ALK gene in CT-guided biopsy of lung cancer. The clinical data of 250 patients with lung cancer from June 2014 to August 2015 in Zhejiang Provincial Cancer Hospital were collected and their CT guided data were collected to analyze the relationship between clinicopathological manifestations and gene mutation. Methods: the clinical data of 250 patients with lung cancer were collected from June 2014 to August 2015 in Zhejiang Cancer Hospital. Biopsy specimens. According to the location and size of the mass, take the appropriate puncture needle, There were 50 cases of fine needle puncture and 200 cases of thick needle. The fine needle was made of Cook 19G coaxial semi-automatic biopsy needle or primace 20g semi-automatic biopsy needle. BioPince 17G coaxial automatic biopsy needle or Prosser 18G ~ + 16G semi-automatic biopsy needle were used to detect the EGFR gene of 250 puncture specimens by ScorPions ARMS. The expression of ALK gene was detected by using the immunohistochemical method of Ventana ALKN D5F3.Results the EGFR gene mutation was found in 103 of the biopsy specimens from 250 patients with NSCLC. The mutation rate was 41.2; the mutation rate of female patients with 6ALK fusion gene. EGFR gene was significantly higher than that of male patients with exon 19 deletion 44.7and exon 21 L858R mutation 39.8%. The mutation rate of EGFR gene in adenocarcinoma was significantly higher than that in smoking patients (56.2%), but there was no correlation between age and stage. The mutation rate of EGFR gene in adenocarcinoma was significantly higher than that in squamous cell carcinoma and other types of lung cancer. No ALK gene expression and sex were found in this study. Age, pathological differentiation and other factors were correlated with P0.05 ALK gene positive in all 15 patients who did not smoke, all of them were adenocarcinoma. The mutation rate of ALK gene in stage 鈪，

本文編號(hào)：1694817