中晚期非小细胞肺癌骨转移与EGFR基因突变相关分析-东南大学学报医学版

中晚期非小细胞肺癌骨转移与EGFR基因突变相关分析

单位：1. 南京医科大学附属儿童医院放射科, 江苏南京 210008;
2. 南京鼓楼医院核医学科, 江苏南京 210008

分类号：R734.2

出版年·卷·期（页码）：2018·37·第四期（711-715）

摘要：

目的：探讨中晚期非小细胞肺癌患者骨转移及表皮生长因子受体（EGFR）基因突变相关性。方法：选取经病理证实且明确EGFR基因有无突变的101例中晚期非小细胞肺癌患者，以^{99 m}Tc-MDP全身骨扫描为主要依据判定患者骨转移结果及分级，采用组间卡方检验及Spearman相关分析评价EGFR基因突变对中晚期非小细胞肺癌患者骨转移发生及发展的预示意义。结果：中晚期非小细胞肺癌骨转移患者中阳性病灶分别为胸部（36.72%）、脊柱（36.26%）、骨盆（15.94%）、四肢（6.93%）及头颅（4.15%）；EGFR突变率腺癌患者明显高于非腺癌患者（P<0.05），EGFR野生组与突变组间骨转移发生、病灶分布及发展无明显差异及相关性（χ²=0.745，P > 0.05；r=0.114，P > 0.05）。结论：中晚期非小细胞肺癌骨转移患者以中轴骨多发转移为主，EGFR基因突变对骨转移的发生倾向及发展的严重程度没有明确预示作用。

Objective:To discuss the clinic characteristic of bone metastasis and EGFR mutation in the moderate non small cell lung cancer and try to analyze the correlation between them. Methods:101 cases with non small cell lung cancer confirmed by pathology were examined with 99 mTc-MDP bone scintigraphy and EGFR gene detection. Chi-square analysis, and spearman correlation analysis were used to evaluate the EGFR mutation in predicting the development of the skeletal metastasis. Results:The skeletal metastasis occurred in:chest (36.72%), spine (36.26%), pelvis (15.94%), four limbs (6.93%), skull (4.15%). EGFR mutation rate in adenocarcinoma was obviously higher than that of no adenocarcinoma patients (P<0.05). There was no obvious difference in the occurrence and development of the skeletal metastasis between the EGFR wild group and the mutation group(χ²=0.745, P > 0.05, r=0.132, P > 0.05). Conclusion:Bone metastasis of non small cell lung cancer is mostly seen in axial skeleton (chest and spine). The EGFR mutation for non small cell lung cancer has no significance in predicting the occurrence and development of bone metastasis.

参考文献：

[1] 孙燕,管忠震,廖美琳,等.肺癌骨转移诊疗专家共识(2014版)[J].中国肺癌杂志,2014,17(2):57-72.
[2] da CUNHA SANTOS G,SHEPHERD F A,TSAO M S.EGFR mutations and lung cancer[J].Annu Rev Pathol,2011,6(6):49-69.
[3] 王晶.第一代靶向药物治疗晚期NSCLC的临床观察[J].现代医学,2015,43(11):1423-1424.
[4] LI B,SUN S Z,YANG M,et al.The correlation between EGFR mutation status and the risk of brain metastasis in patients with lung adenocarcinoma[J].J Neuro-oncol,2015,124(1):79-85.
[5] MATSUMOTO S,TAKAHASHI K,IWAKAWA R,et al.Frequent EGFR mutations in brain metastases of lung adenocarcinoma[J].Int J Cancer,2006,119(6):1491-1494.
[6] SOLOWAY M S H S,HICKEY D. Stratification of patients with metastatic cancer based on extent of disease on initial bone scan[J].Cancer,1988,61(1):195-202.
[7] WILSON M A,CALHOUN F W.The distribution of skeletal metastases in breast and pulmonary cancer:concise communication[J].J Nucl Med,1981,22(7):594-597.
[8] 郭庆志,吴梅娜,安彤同,等.322例非小细胞肺癌骨转移临床特点及治疗的回顾性分析[J].中国肺癌杂志,2014,17(9):656-662.
[9] ABDURAHMAN A,ANWAR J,TURGHUN A,et al.Epidermal growth factor receptor gene mutation status and its association with clinical characteristics and tumor markers in non-small-cell lung cancer patients in Northwest China[J].Mol Clin Oncol,2015,3(4):847-850.
[10] SAKURADA A,SHEPHERD F A,TSAO M S.Epidermal growth factor receptor tyrosine kinase inhibitors in lung cancer:impact of primary or secondary mutations[J].Clin Lung Cancer,2006,7(Suppl 4):138-144.
[11] 赵钊,陈盼盼,张萍.NSCLC患者EGFR基因突变与血清肿瘤标志物相关性分析研究[J].中国卫生检验杂志,2014,24(15):2217-2219.
[12] EICHLER A F,KAHLE K T,WANG D L,et al.EGFR mutation status and survival after diagnosis of brain metastasis in nonsmall cell lung cancer[J].Neuro-oncol,2010,12(11):1193-1199.
[13] DOEBELE R C,LU X,SUMEY C,et al.Oncogene status predicts patterns of metastatic spread in treatment-naive nonsmall cell lung cancer[J].Cancer,2012,118(18):4502-4511.
[14] 江曼,钱晓萍,杨阳,等.TS及EGFR在非小细胞肺癌中的表达及其临床意义[J].江苏医药,2014,40(11):1289-1291.
[15] HENDRIKS L E,SMIT E F,VOSSE B A,et al.EGFR mutated non-small cell lung cancer patients:more prone to development of bone and brain metastases?[J].Lung Cancer,2014,84(1):86-91.
[16] NAGATA M,KUDOH S,MITSUOKA S,et al.Skeletal-related events in advanced lung adenocarcinoma patients evaluated EGFR mutations[J].Osaka City Med J,2013,59(1):45-52.
[17] CONFAVREUX C B,GIRARD N,PIALAT J B,et al.Mutational profiling of bone metastases from lung adenocarcinoma:results of a prospective study (POUMOS-TEC)[J].Bone Key Rep,2014,3(10):580-587.
[18] ZHU J,JIA X,XIAO G,et al.EGF-like ligands stimulate osteoclastogenesis by regulating expression of osteoclast regulatory factors by osteoblasts:implications for osteolytic bone metastases[J].J Biol Chem,2007,282(37):26656-26664.
[19] 方勤,张亮,王思愚,等.非小细胞肺癌原发灶与相应转移灶之间EGFR基因突变状况的不一致性研究[J].中国肺癌杂志,2011,14(6):518-522.
[20] CANON J,BRYANT R,ROUDIER M,et al.Inhibition of RANKL increases the anti-tumor effect of the EGFR inhibitor panitumumab in a murine model of bone metastasis[J].Bone,2010,46(6):1613-1619.
[21] 华丽蕈,岳海英,黄东宁.EGFR和KRAS基因状态对肺癌脑转移放疗敏感性的影响[J].东南大学学报(医学版),2016,35(6):947-951.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录