Study On The Influencing Factors Of Tumor Mutation Burden In Non-small Cell Lung Cancer Patients And Their Correlation Analysis

BackgroundThe most common pathological types of non-small cell lung cancer(NSCLC)include lung adenocarcinoma and lung squamous cell carcinoma.Studies on the treatment of NSCLC show that immunotherapy has become an important treatment strategy besides chemotherapy,radiotherapy and targeted therapy.Recent studies have shown that immunotherapy has a significant survival advantage over chemotherapy in some patients with NSCLC,but it has the disadvantage of a low overall response rate.Therefore,it is of great significance to select effective and reliable biomarkers for NSCLC patients.A growing number of evidence shows that Tumor mutation burden(TMB)is an effective biomarker for predicting the efficacy of immunotherapy in patients with NSCLC.However,the existing literature on TMB in NSCLC patients is often limited to its prediction and evaluation of the effect of immunotherapy.Most of the TMB used in China are the results of NGS detection and calculation.However,there are some limitations in the detection of TMB:1.The feasibility of TMB detection in China is low,and the detection of TMB is less;2.It takes a long time,usually 7-10 days;(3)High prices.Therefore,it is of great significance to predict TMB more rapidly and economically through some common clinicopathological indicators.Moreover,there are few studies on the relationship between TMB and clinicopathological characteristics,driver genes and imaging examinations in NSCLC patients.AimThis study explores the correlation of TMB and clinicopathological characteristics in NSCLC patients,so as to use common indicators to quickly predict the value of TMB in patients,and explore the relationship between TMB and drive genes,and the relationship among TMB,PD-L1 and SUVmax to provide guidance for patients in TMB detection and immunotherapy,and predict immunotherapy effects.In this study,the correlation between TMB and clinicopathological characteristics of EGFR mutation NSCLC patients were explored,thereby realizing reasonable prediction of gene EGFR mutant treatment effects using common clinical pathological characteristics.MethodsThe clinicopathological characteristics,tumor markers and NGS test results of 93 NSCLC patients with TMB tested in the First Affiliated Hospital of Zhengzhou University from January 2017 to April 2019 were retrospectively analyzed to study the relationship between TMB and clinicopathological characteristics.And the factors influencing the clinical characteristics of TMB were comprehensively analyzed by multiple linear regression method.The correlation between driving genes and TMB was also analyzed.In addition,the relationship among TMB,PD-L1 and SUVmax was explored.Results(1)For NSCLC patients,the distribution of smoking history and pathological types are different between the low TMB expression group and the high TMB expression group,and the difference is statistically significant(P<0.05).Multiple linear regression indicated that TMB is closely related to age,smoking history and pathological type(P<0.05).(2)There is no correlation between the driver gene and TMB(P>0.05),while EGFR gene mutation is associated with TMB expression(P<0.05).The expression of BRCA2 was correlated with that of TMB(P<0.05),while the expression of TP53 was not correlated with that of TMB(P>0.05).(3)For NSCLC patients with EGFR mutation,TMB is correlated with age and smoking(P<0.05).(4)SUVmax value has no correlation with TMB(r=0.230,P>0.05),but has correlation with PD-L1(r=0.490,P<0.05).Conclusion(1)For patients with NSCLC,TMB is closely related to age,smoking history and pathological type,and the combination of the three indexes can predict TMB value,so as to guide the choice of treatment for patients and predict the effect of immunotherapy.At the gene level,EGFR and BRCA2 are related to TMB and have certain predictive significance for TMB.(2)For patients with EGFR-mutated NSCLC,older and smoking patients have higher TMB,which indicates that targeted therapy is less effective in older and smoking EGFR-mutated NSCLC patients,and the effect of immunotherapy is better.(3)SUVmax has a certain predictive value for PD-L1,suggesting that PET-CT can be recommended clinically for NSCLC patients to guide the selection of treatment and the prediction of the effect of immunotherapy.