Analysis Of Molecular Pathologic And Clinical Features Of 36 Patients With Pulmonary Sarcomatoid Carcinoma

Objective:Pulmonary sarcomatoid carcinoma is a group of non-small cell lung cancer with low incidence,high heterogeneity and invasiveness.Compared with other types of NSCLC,the prognosis of PSC is poor.Therefore,it is of great significance to understand the characteristics of molecular pathologic.It can improve the therapeutic effect and prolong the survival period.In recent years,the next generation sequencing technology has been developing rapidly.It is possible to improve the effectiveness of clinical cancer treatment by targeting therapy.At the same time,this technique is gradually used to study the characteristics of rare tumor gene mutation,which can provide reference for molecular targeting therapy.In this study,use NGS to detect tumor tissue 422 cancer-related genes and to analyze prognosis of survival,in order to find the guidance of diagnosis and targeted therapy,to provide new ideas for the diagnosis and treatment of this disease.Materials and Methods:A total of 36 patients with PSC who were resected and diagnosed in The First Hospital of Jilin University and Jilin Cancer Hospital from June 2011 to June 2017 were collected.13 cases were followed up successfully,and the last follow-up time was January 30,2018.The NGS was used to sequence the exon of the whole oncogene in 36 patients,and the detailed gene mutation data were obtained.The experimental data were analyzed by SPSS22.0 statistical software,and the difference of p<0.05 was statistically significant.Kaplan-Meier method was used for single factor prognosis analysis.The COX proportional hazards model was used to analyze the prognosis of multiple factors.Results:19 high frequency mutations were identified.TP53(69.4%),PKD1(38.9%),THADA(33.3%),KRAS(30.6%),RB1 single copy deletion(30.6%),PIK3CA(25.0%),EGFR(19.4%),NF1(16.7%),PTCH1(16.7%),BRCA1(16.7%),BRAF(16.7%),ARID1A(16.7%),MTOR(16.7%),MET(13.9%),CREBBP(11.1%),ARID2(11.1%),ALK(11.1%),CDK12(8.3%),EMLA4-ALK fusion(5.6%).Kaplan-meier single factor survival analysis found that KRAS,BRCA1,ALK mutations were associated with the overall survival of PSC(p=0.018,p=0.000,p=0.038).There was no correlation between sex,age,tumor diameter,smoking history,TNM stage and overall survival(p>0.05).Multiple factor analysis of the COX proportional hazards model showed that KRAS mutation was an independent factor in the overall survival of PSC(HR,5.92;95% CI,1.14-30.66;p =0.034).Conclusion:1.36 PSC patients were enrolled in this study,and 19 high frequency gene mutations were selected.2.The gender,age,smoking history,tumor diameter,tumor location,T stage,N stage,clinical stage,pathological classification,and treatment were not significantly correlated with OS.3.The KRAS mutation was an independent factor affecting the OS,and the OS of KRAS mutant was significantly shorter than KRAS wild-type.4.Using NGS,we can find that PSC has the characteristic gene mutation,which may guide clinical targeted therapy in the future.