Clinical Characteristics And Prognosis Of Patients With Advanced Lung Adenocarcinoma With Co-mutation Of TP53/EGFR Gene

ObjectsTo study the clinical characteristics of patients with advanced lung adenocarcinoma with co-mutation of TP53 and epidermal growth factor receptor,(EGFR)gene and the effect of co-mutation on the prognosis of patients.Methods72 patients with stage ⅢB-Ⅳ EGFR mutation lung adenocarcinoma were selected from the respiratory department,oncology department and cardiothoracic department.All the patients received EGFR-tyrosine kinase inhibitor(TKI)single drug targeted treatment.The blood routine,blood biochemistry,tumor markers,ECG and imaging were reviewed 28 days after the first treatment and every 2 months after the first treatment.Follow-up visits of all patients were executed through regular visits to the hospital or through telephone calls.The start time of the follow-up was February 2014,and the end date was June 1,2019.Data were statistically analyzed using SPSS 26.0.Results1.Among the 72 patients with positive EGFR mutation,the TP53 mut-ation rate was 29.17%(21/72).Through comparison of aspects including the age and gender of smoker,degree of tumor stage differentiation,brain met-astasis,and type of EGFR gene mutation,a significant difference was discovered in the TP53 mutation in the patients with smoking and brain metastasis(P<0.05).2.The median progression free survival(PFS)and median overall survival(OS)of patients with TP53 mutations were both shorter than those without TP53 mutations(PFS:8.4 months VS 11.0 months,P=0.135).Objective response rate(ORR)and disease control rate(DCR)of patients with TP53 mutation group were lower than those without TP53 mutation group(ORR:11.11% VS 30.56%,P=0.006).DCR: 15.28% VS 62.50%,P=0.005).3.Univariate analysis of patients with EGFR mutant lung adenocarcinoma showed that TP53 mutation(P=0.000),smoking(P=0.001),tumor stage(P=0.000)and brain metastasis(P=0.000)were prognostic factors.In mul-tivariate analysis,TP53 mutation(P=0.000),age(P=0.011),tumor stage(P=0.000)and brain metastasis(P=0.000)were independent prognostic factors in patients with EGFR mutant advanced lung adenocarcinoma.4.Univariate analysis of patients with lung adenocarcinoma with comutated TP53/EGFR gene showed that tumor stage(P=0.007)and brain metastasis(P=0.034)were prognostic factors.In multivariate analysis,brain metastasis(P=0.021)was an independent prognostic factor for patients with lung adenocarcinoma with co-mutated TP53/EGFR gene.Conclusions1.Mutations in the TP53 gene can lead to shortened OS,decreased efficacy of EGFRTKI and poor prognosis in patients with advanced lung adenocarcinoma with EGFR mutation.2.TP53 gene mutation age brain metastasis in tumor stage is an independent risk factor affecting the prognosis of patients with EGFR mutant advanced lung adenocarcinoma.3.Brain metastasis is an independent risk factor affecting the prognosis of patients with advanced lung adenocarcinoma with co-mutation of TP53/EGFR gene.