Clinical Pathological Characteristics And Treatment Patterns Of EGFR Rare Mutation In Non-small Cell Lung Cancer

Objective:Retrospective analysis of the clinicopathological characteristics,mutations,treatment mode selection,treatment effects and survival of patients with rare EGFR gene mutations in NSCLC provides a basis for the diagnosis and treatment of rare EGFR mutation NSCLC patients.Methods: Collected the case data of 240 patients diagnosed with NSCLC by pathology or cytology in the Department of Oncology of the Fourth Hospital of Hebei Medical University from February 2016 to December 2019.The clinical pathological characteristics,mutations and treatment of the patients were collected.Wait for analysis and comparison.Results:1.Clinical and pathological characteristics1.1 General information109(45.4%)of 240 patients with genetic testing had EGFR gene mutations,including 85(78.0%)classic mutations,19(17.4%)rare mutations,and 5(4.6%)mutation sites are unknown.1.2 Clinical and pathological informationThe median age of 19 rare mutation patients was 55 years old,6 cases(31.6%)> 60 years old,13 cases(68.4%)?60 years old;4 males(21.1%)and 15 females(78.9%);families with cancer 2 cases(10.5%),17 cases(89.5%)without family history of tumor;17 cases(89.5%)of adenocarcinoma,1 case(5.3%)of squamous cell carcinoma,1 case(5.3%)of other non-NSCLC;the metastatic site was 8 cases of bone(42.1%),6 cases of brain(31.2%),5 cases of liver(26.3%),3 cases of pleura(15.8%);3 cases(15.8%)),12 cases of single organs(63.2%).There was no statistically significant difference in age,gender,smoking status,tumor family history,pathological type,etc.between the rare and classic mutation patients(P> 0.05).2.Gene mutationsAmong of 19 rare patients with mutations,6(31.6%)had single mutations and 13(68.4%)had compound mutations.The single mutation gene was 3 cases of exon20ins(50%),1 case of exon20S768I(16.7%),1 case of exon19ins(16.7%)and so on.There were 6 cases(53.8%)of L858 R in the compound mutant gene.3.Treatment model selectionOf the 19 rare mutation patients,14(73.7%)chose TKI therapy,of which 7(50%)were treated with TKI alone and 7(50%)were combined with other treatments based on EGFR-TKI;other treatment,one case is unknown.4.Subsistence analysisThe median PFS of classic mutations and rare mutations were 12.0 and 6.9 months,P = 0.004;the median OS was 45.0 and 19.0 months,P =0.001.For classic and rare mutations treated with simple TKI,the median PFS was 13.0 and 9.5 months,P = 0.154;the median OS was 45.0 and 19.0 months,P = 0.000.TKI combined treatment of classic mutations and rare mutations,median PFS were 13.0 and 5.0 months,P = 0.004.5.Prognostic analysisAge,family history of tumors,first stage,mutation type were independent factors that influenced the prognosis of EGFR mutation NSCLC progression.Smoking status and mutation type are independent prognostic factors that affect the death of EGFR mutant NSCLC.Conclusion:1.Among the rare EGFR mutations,the single mutation gene is the most common with exon20 ins,and the compound mutation is the one with L858 R.2.EGFR-mutated NSCLC is dominated by females,non-smokers,and adenocarcinoma patients.Classical and rare mutations have similar performance.3.The treatment of patients with rare EGFR mutations is based on molecular targeted drugs.The main treatment modes include simple TKI therapy or combined chemotherapy based on TKI,anti-angiogenesis targeted therapy or radiation therapy.Rare mutation therapy is less effective than classic mutations,so individual analysis is needed clinically.4.The type of mutation is an independent prognostic factor that influences the progression of disease and the risk of death in patients with non-small cell lung cancer,that is,a rare mutation is a poor prognostic factor for NSCLC.