The Analysis Of Surgical Prognostic Factors And Molecular Typing Of Locally Advanced Lung Squamous Cell Carcinomas

Lung cancer remains the single deadliest cancer worldwide,squamous cell carcinoma(SCC)of the lung is a unique clinical and histologic category of NSCLC and accounts for about 30% of all lung cancer,Although substantial advances have been made in nonsquamous NSCLC,an unmet need exists for effective therapies in squamous NSCLC.Surgical intervention is the current principal treatment for SCC of the lung,but there are many individual factors that affect the outcome of surgical treatment.Many of these are stage IIIA,IIIB,or IV at the time of diagnosis.Surgical treatment of these patients is controversial.A few large series have been reported in the medical literature,but patient characteristics and prognosis remain poorly defined.We retrospectively evaluated the files of 170 patients with squamous NSCLC who were treated at the department of lung cancer surgery,Tianjin Medical University General Hospital,between January 2008 and December 2011.Univariate(Cox regression analysis)and multivariate(likelihood ratio)analyses were carried out for overall survival(OS)and the median survival duration.The result show that the median OS was 29 months,the 1-year OS was 78.2%,and the 5-year OS was 15.3%.On univariate analysis,the Eastern Cooperative Oncology Group Performance Status(ECOG-PS)score;tumor(T)stage;node(N)stage;type of surgery;type of lymphadenectomy;and the presence of residual carcinoma at the incised margin,intravascular cancer,and pleural effusion were significa ntly related to patient survival(P < 0.05).O n multivariate analysis,the smoking index(P = 0.002),ECOG-PS(P = 0.000),T stage(P = 0.005),and N stage(P = 0.000)were independent prognostic factors.The OS of patients with squamous lung carcinoma was low.The survival rates gradually decreased as patients' ECOG-PS declined.The patients without lymph-node involvement(N0)had longer survival than those with N1 and N2 lymph-node involvement.Both OS and disease-free survival are worse in SCC of the lung than for NSCLC in general.At present,we still depend on surgical intervention for squamous NSCLC;there is an unmet need for novel effective therapies.We collected the data of CEA,NSE,CYFRA21-1,SCC-Ag from 170 squamous lung cancer patients and analysed the relationship between tumor markers and the diagnosis and prognosis of lung squamous cell cancer.The result show that CYFRA21-1 and NSE were significantly higher in advanced T stage squamous cell cancer than in early T stage.SCC-Ag was significantly higher in advanced N stage than eraly.All of them were nonspecific prognostic factor in the operable patients.And the CEA had little diagnosis and prognositic significance.At last,we detected the mutation of 56 drivegenes related in lung cancer by NGS for two group of lung squamous cell cancer patients.A meta-analysis was performed on the eligible studies,which quantitatively evaluated the association between the TP53 mutations and the survival of patients with lung squamous cell carcinoma.The overall survival was more than 3 years in one group and less than 1 year in the other.All of these patients were locally advanced stage and had undergo the surgery.The result show that 21(87.5%)samples were deceted mutation,12 samples(50%)were PI3K/AKT pathway mutation,7 samples(29.1%)were ERBB family mutation,3 samples(12.5%)were C DKN2A/RB1 pathway mutation and JAK family mutation and 6 samples(25.0%)were NOTCH1 mutation.The mutation of TP53 and NOTCH1 are present in one patient,and the overexpression of CCND1,FGF3,PIK3 CA may associated with poor survival.And we need to be more carfully to surgical management for these patiets.The mutation of EGFR may associated with sensitive to EGFR-TKI and prolong survival.The detected of mutation for lung sq uamous cell cancer and the moleculer classification of oncogene is necessory for indicated individualized treatment and the operation.