Study On The Relationship Between Vascular Mimicry And Therapeutic Response And Prognosis In EGFR Mutant Lung Adenocarcinoma

Objective:This paper aims to study the relationship between vasculogenic mimicry and therapeutic response and prognosis in EGFR mutant lung adenocarcinoma.Methods:The medical records of lung adenocarcinoma with EGFR mutation in Taizhou Second People's Hospital from March 1,2013 to March 1,2016 were collected.The required pathological sections were detected for vasculogenic mimicry(VM)using CD34-PAS double staining.According to the treatment regimens,patients were divided into chemotherapy group and TKI group.The treatment response(ORR,DCR)and progression-free survival(PFS)of each group were calculated respectively.Results:131 patients with an average age of 60±11 years,66 males(50.38%),66 women(49.62%),81 patients in chemotherapy group(61.83%),50 patients in TKI treatment group(38.18%).Of the 131 cases of lung adenocarcinoma,45 cases(34.5%,45/131)had typical VM structure,including 25 cases in the chemotherapy group and 20 cases in the TKI treatment group(P=0.285).VM was significantly correlated with differentiation and M-stage(r=0.402,0.334,P<0.01).Patients in chemotherapy group received an average of 4.7 courses of chemotherapy,CR 0%,PR 40.74%,SD 23.46%,PD 35.80%,ORR 40.74%,DCR 64.20%,CR4.00%,PR38%in TA group,PR38%,PR38.0%,SD 34.00%,PD24.00%ORR42.00%,DCR66.00%.There was no significant difference in ORR and DCR between the two groups(p=0.887,p=0.834).In the evaluation after 4 cycles of treatment,29 patients of chemotherapy group and 12 patients of TKI group were confirmed as progress.There was no significant difference between the two groups(p=0.157).The median PFS in chemotherapy group was 210 days,and the median PFS in TA group was 299 days.There was significant difference between the two groups(P<0.001).The median PFS of VM positive patients in chemotherapy group was 201 days,and that of PFS negative patients was 221 days(p=0.197);the median PFS of VM positive patients in TA group was 221 days,and the PFS of negative patients was 313 days.There was significant difference between the two groups(p<0.001).Conclusion:The TKI treatment of lung adenocarcinoma with EGFR mutation was significantly longer than that of chemotherapy PFS,and the TKI treatment of VM negative patients significantly prolonged PFS compared with VM positive performance,but the difference was not significant in chemotherapy patients.The appearance of VM shows that tumor cells have high invasiveness,poor differentiation,easy metastasis and poor prognosis.