The Clinicopathologic Prognosis Factors And Gene Mutation Detection In Lung Adenocarcinoma

Objective: To discuss the prognosis factors about clinical,radiological characteristicsand histological subtypes，and to detect the gene mutation of EGFR and EML4-ALKin lung adenocarcinoma.Materials and Methods：There were309cases of lung adenocacinoma were collectedfrom our hospital between October1995and March2013, others446cases collectedthe last two years, which have been detected mutation of EML4-ALK and EGFR at thesame time. All pathological slides were reviewed and reclassificated according toIASLC/ATS/ERS suggested the newest pathological subtyping of lung adenocacinoma.We study the gene mutations of EML4-ALK and EGFR in lung adenocarcinoma.Results:1. Among309cases of lung adenocarcinoma，147cases were male and162cases were female, with an average age of60.4years,224(79%) cases were non-smokers, and the majority of patients were stage I (n=254,82.2%),35patients dead.After reclassification, there were20case of AIS,69case of MIA,77cases of LPA,78cases of acinar predominant,30cases of micropapillary predominant,20cases ofinvasive mucinous adenocarcinoma and12cases of solid predominant with mucinproduction.21cases occurred distance metastasis of lymph notes and39case withpleura invasion.The statistics data show that tumor size, pleura invasion, radiologicalchange and histological subtypes were danger factors of prognosis in lungadenocarcinoma.Seventy-six cases with pGGO and seventy-four case with solid nodulon CT were discuss.The former included8case AIS,26cases of MIA,29cases ofLPA,10cases of acinar predominant,2case of micropapillary predominant and1casesolid predominant with mucin production.The latter all cases were invasive lungadenocarcinoma, none preinvasive lesions.Among446cases of lung adenocarcinoma, there were267male and179female, meanage56.1years. EML4-ALK fusion genes have been found in38cases.The mutation rate was8.5percent.The Statistics show that patient’s age, smoke station and histologysubtypes influence the gene mutation.The patients with none mutation of EGFR havehigh gene rearrangement rate (14.1%).We detect EGFR gene mutation in446case of lung adenocarcinoma, the mutationrate was43.7%. The most common mutation was deletions in exon19and exon21. Sex,smoke station and tumor size show significant associations with frequency of EGFRmutations.Age, lymph note metastasis, pleural invision and pathologic stage did notshow significant associations with frequency of EGFR mutation. Otherwise, three caseshave been found both mutation in EML4-ALK fusion genes and EGFR.Conclusions:1、The statistics data show that tumor size, pleura invasion, radiologicalchange and histological subtypes were danger factors of prognosis in lungadenocarcinoma.The newest subtypes classification can response the prognosis of eachsubtype in lung adenocarcinoma. Both AIS and MIA had the best prognosis,LPA had better prognosis.2、The overall Epidermal growth factor receptor mutations rate was43.7%in446cases of lung adenocarcinoma.There were a higher EGFR mutation rate infemale,non-smoker and tumor size less than three centimeter among patient with lungadenocarcinoma.3、The EML4-ALK fusion gene detection rate was8.5%in446cases of lungadenocarcinoma. The patients with none mutation of EGFR have high gene mutationrate (14.1%). There were a higher EML4-ALK fusion gene detection rate in female,non-smoker and histological substypes of invasive mucinous adenocarcinoma，Solidpredominant with mucin production andmicropapillary predominant adenocarcinoma.