EGFR Mutation Profile, EGFR-TKIs Effecacy Correlated With The Novel Histological Subtypes Based On2011Lung Adenocarcinoma Classification Standard

Objective：1．To study the distribution of EGFR mutations in subtypes of invasive lungadenocarcinoma based on2011Lung Adenocarcinoma Classification Standard.2．To investigate the relvance between histological subtypes and the efficacy ofEGFR-TKIs．Methods：1． Case collection：Choose the advanced and EGFR mutation positive lungadenocarcinoma patients who accept or not the EGFR-TKIs treatment to the studyform Jun1，2009to Dec30，2012from Fuzhou General Hospital of Nanjing MilitaryRegion．2．Tissue classification：Reclassification based on2011Lung AdenocarcinomaClassification Standard. The solid adenocarcinomas are required to IHC to excludesquamous cell carcinoma．3．EGFR mutations detected：EGFR mutation was detected by RT-PCR．4．According RECIST I.1standards, assessed the efficacy．5．Statistical methods: all data using SPSS16.0statistics．Descriptive analysis of thedistribution of histological subtypes method with EGFR mutations．All are made oftwo-sided test of hypothesis testing, confidence interval with95%．X2and Fisher isusing to analyze datas discrepancies．Kaplar-Meier is using to analyze of survival．P≤0.05was considered as statistically significant difference test．Results：1．Collected192cases enrolled in the study，91male (47.4%)， female101(52.6%)，the min age of34years，the max age of88years，median age58years，130cases of non-smokers，smokers62cases，A total of83patients were received EGFR-TKIs treatment．2．According to the new classification criteria：acinar predominant were53.1%，solidpredominant were20.3%， spikes like predominant were14.6%， papillarypredominant were7.3%，micro-papillary predominant were4.7%，the most commontype is acini acinar predominant．3．The EGFR gene：18point mutations were2.1%，19point mutations were52.6%，20point mutations were1.0%，21point mutations were44.3%．It found thatsignificant difference between DCR and histological subtypes（P=0.046）．4．The patients who received EGFR-TKIs treatment DCR was77.1%，alveolarpredominant DCR was82.9%，solid-predominant DCR was50%，like spikes typeDCR was92.9%，papillary and micropapillary predominant DCR was66.6%．Itsfound that significant difference between EGFR19、21mutations and differenthistological subtypes．It found that significant difference between EGFR19、21mutations and histological subtypes （P=0.024）．5．The patients mPFS was16.0ms，alveolar predominant mPFS was17.0ms，solidpredominant mPFS was7.0ms，spikes predominant mPFS was18.0ms，papillaryand micropapillary predominant mPFS was12.0ms．Its found that significantdifference between PFS and alveolar predominant/solid predominant/spikespredominant（P=0.025）．Conclusions：1．EGFR mutations is closely associated with histological subtypes and it is commonin alveolar–predominant；2．Histological subtypes are relative of EGFR19、21point mutations；3．Spikes predominant who accepted EGFR-TKIs has a best DCR and PFS，but solidpredominant is the worst．4．In EGFR19、21point mutation subgroup，The DCR is no different withhistological subtypes．...