Correlation Of EGFR Mutation Status And Clinical Characteristics In Advanced Non-small Cell Lung Cancer

Objective To explore the correlation between the mutation status of epidermal growth factor receptor(EGFR)gene and the clinical characteristics of in patients with advanced non-small cell lung(NSCLC)cancer.Methods:From January 2013 to December 2017,156 patients diagnosed with advanced non-small cell lung cancer(NSCLC)in respiratory department of the Second Affiliated Hospital of Suzhou University were retrospectively studied.The patients were divided into EGFR mutation group and EGFR wild type group.The age,sex,smoking history,pathological type,differentiation degree,CT imaging features,erum tumor markers,lipid metabolism and neutrophil lymphocyte ratio(NLR)at diagnosis were analyzed by single factor analysis.Multivariate logistic regression was used to analyze the risk predictors of EGFR mutation in relation to oncology indicators.Result:Among the 156 patients with NSCLC,there were nine patients with stage IIIB(5.8%)and 147 patients with stage IV(94.2%).There were 76 patients with EGFR gene mutation,the total mutation rate was 48.7%.The overall age distribution of the patients ranged from 33 to 88(64.99±10.86)years old.The average age of EGFR gene mutation group was(63.11±10.39)years old,The average age of EGFR gene wild type group was(66.79±11.06)years old.There were 39(58.2%)EGFR mutations in female patients and 37(41.6%)in male patients.EGFR mutation occurred in 39(58.2%)female patients and 37(41.6%)male patients.21 patients(31.8%)in the EGFR mutant group had a history of smoking,compared with 45(68.2%)in the wild type group.The pathological types of the lung cancer patients investigated were mainly lung adenocarcinoma(87.2%),EGFR mutation rate was 52.2%.In EGFR mutation group,nine cases(29.0%)had low differentiation,42 cases(60.3%)had moderate differentiation and 25 cases(52.1%)had high differentiation.The main mutation sites were exon 19(57.9%)and exon 21(36.8%).When CEA<5ng/mL,the mutation rate of EGFR gene was 30.4%,when CEA was 5-20ng/mL,the mutation rate of EGFR gene was 38.5%,and when CEA>5ng/mL,the mutation rate of EGFR gene was 67.1%.The median maximum diameter of tumor in the EGFR gene mutation group was 26(17.50,39.75)mm,The median maximum diameter of tumor in wild type group was 40(32.25,53.00)mm,By comparing the gene mutation rates of CT signs such as Lobulation sign,spicule sign,cavitary,Vascular convergence sign,pleural effusion and pleural indentation,it was found that there were differences in gene mutation rates of pleural indentation group(58.3%vs 41.7%).From the ROC curve,we can see that the best critical value(Cut-off)for diagnosis of EGFR gene mutation in advanced NSCLC patients by NLR is 2.645,and the area under the curve is 0.652(95%CI 0.565-0.739,P=0.001).According to Cut-off value,NLR was divided into high and low groups.The mutation rate of EGFR in low level NLR group was significantly higher than that in high level NLR group(63.6%VS34.2%).The risk factors for EGFR gene mutation in patients with advanced NSCLC were analyzed by single factor Logistic regression analysis.Smoking history,sex,pleural indentation sign,NLR,tumor maximum diameter,CEA and so on were associated with EGFR gene mutation.The independent variables of univariate P<0.1 were included in the multivariate analysis.The results showed that small diameter of tumors,non-smoking history,elevated serum CEA,with pleural indentation sign and low level NLR were main the risk factors of EGFR gene mutation in patients with advanced NSCLC.Conclusion:1.The EGFR mutation in advanced non-small cell lung cancer is more common in adenocarcinoma,female and non-smoking patients.Patients with pleural indentation,elevated serum CEA,low level NLR and small diameter of tumors had higher EGFR mutation rate.2.The main risk factors of EGFR gene mutation in advanced NSCLC patients are:small diameter of tumors,non-smoking history,elevated serum CEA,with pleural indentation sign and low level NLR.