Correlation Analysis Of Common Gene Mutations And Clinical Factors In Non-small Cell Lung Cancer

Objective To analyze the mutations of common driver genes in patients with NSCLC in Changde area,and to explore the relationship between these gene and clinical factors.In order to providing a basis for screening patients who benefit from gene testing and targeted therapy.Methods 1.Through the screening admission criteria,finally collection of clinical data of 340 patients were retrospectively analyzed,who were first time diagnosed with NSCLC in the First People’s Hospital of Changde City from January 1,2018 to December 31,2019.2.Next-generation sequencing technology was used to detect the mutations of lung cancer driver genes in 340 patients with NSCLC.3.Collection clinical data in the electronic case system,including gender,smoking history,age,ECOG score,tumor situation,pathological type,TNM stage,metastasis location,differentiation degree,etc.Meanwhile collection the white blood cell count,lymphocyte count,NLR,LMR,PLR,SIRI and other inflammatory indicators according to blood routine on admission;Detection of serum tumor markers on admission,and gather to the CEA,Cyfra21-1,NSE.4.To compare the differences from the 8 driver gene mutation status of lung cancer in the clinicopathological characteristics,peripheral blood inflammatory indicators and serum tumor markers respectively,and ROC curve was used to analyze the diagnostic value of peripheral blood inflammatory indicators for gene mutations.Implement multivariate logistic regression analysis to analyze independent factors affecting gene mutations.Statistical analysis was processed with SPSS 25.0 statistical software,P<0.05 suggested that the difference was statistically significant.Results 1.Single gene mutation rate:Among the 340 patients with NSCLC,182 cases were detected the driver gene mutations,with 53.5%total mutation rate,of which the EGFR gene mutation rate was 43.5%(148/340),the KRAS gene mutation rate was 13.5%(46/340),2.6%(9/340)ALK fusion mutation rate,1.8%(6/340)HER2 gene mutation rate,1.2%(4/340)BRAF gene mutation rate,0.9%(3/340)RET gene mutation rate,and ROS1 and MET gene mutation rates were 0.3%(1/340).2.Double gene mutation rate:Among 182 patients with gene mutations,34 patients were found to have polygenic mutations,including 30 cases(8.8%)with EGFR combined KRAS mutations,2 cases(0.6%)with EGFR combined HER2 mutations,1 case(0.3%)with RET combined HER2 mutations,and 1 case(0.3%)ALK combined KRAS mutations.In addition,10 patients(2.9%)had EGFR single-gene double-site mutations.3.Univariate analysis of gene mutations and clinicopathological characteristics with NSCLC showed:EGFR gene mutations are related to gender,smoking history,tumor location,pathological type,TTF-1,NapsinA,CK-7,bone metastasis,lung metastasis(P<0.05).EGFR gene mutations are likely to occur in women,non-smokers,adenocarcinoma,TTF-1 positive,NapsinA positive,CK-7 positive patients;KRAS gene mutations are related to ECOG scores and pathological types(P<0.05),KRAS gene mutations are more common in patients with the ECOG score of 0-1 and adenocarcinoma;HER2 gene mutations are related to the degree of tumor differentiation(P<0.05);There was no significant correlation between ALK,BRAF,RET,MET,ROS1 gene mutation and clinicopathological features(P>0.05).4.Univariate analysis of gene mutations and peripheral blood inflammatory indexes with NSCLC showed:EGFR mutation status was related to white blood cell count,neutrophil count,monocyte count,platelet count,NLR,LMR,and SIRI(P<0.05).White blood cell count,neutrophil count,monocyte count,platelet count,NLR,and SIRI in EGFR mutant patients were lower in wild type patients.LMR in EGFR mutant is higher than wild type patients.ROC curve analysis suggested that single inflammatory index and compound inflammatory index have predictive value for EGFR gene mutation;BRAF mutations were associated with monocyte count,LMR,SIRI(P<0.05),and monocyte count and SIRI in BRAF mutant patients were higher than those in wild type,while LMR lower than those in wild type.ROC curve analysis suggested that monocyte count,LMR,SIRI could predict KARS gene mutation;There was no significant correlation between KRAS,ALK,HER2,RET,MET,ROS1 and peripheral blood inflammatory index(P>0.05).5.Univariate analysis of gene mutations and serum tumor markers with NSCLC showed:EGFR mutation status was associated with CEA,Cyfra21-1 and NSE(P<0.05),and EGFR gene mutations were more prone for to the CEA high group,Cyfra21-1 liters high group and NSE normal group;KRAS gene mutation was linked to Cyfra21-1(P<0.05),KRAS gene mutation was more common in Cyfra21-1 elevated group;HER2 gene change status is related to CEA(P<0.05),HER2 gene mutations easily appeared in the CEA high group;There were not significantly connection between ALK,B RAF,RET,MET,ROS1 mutations and CEA,Cyfra21-1,NSE(P>0.05).6.Multivariate analysis of clinical factors of common gene mutations in NSCLC showed:pulmonary metastasis,CEA,and pathological type are independent risk factors for EGFR gene mutation.ECOG scores,pathological types,and Cyfra21-1 are independent risk factors for KRAS gene mutations.There were no found independent risk factors about ALK,HER2,BRAF,RET,MET,ROS1 gene mutations.Conclusion 1.The common driver gene mutation is EGFR gene,KRAS gene in patients with NSCLC in Changde area,and EGFR/KRAS double gene co-mutation is more common than other types of gene co-mutation.2.EGFR gene mutations are prone to occur in women,non-smokers,adenocarcinoma components,CEA elevated,Cyfra21-1 elevated,NSCLC patients with NSE normal.Peripheral blood inflammatory indicators have predictive value for EGFR gene mutations.Lung metastasis and pathological type are positively correlated with EGFR gene mutation,CEA is negatively correlated with EGFR gene mutation.3.KRAS gene mutations are likely to occur in NSCLC patients with ECOG scores of 0-1,adenocarcinoma components,and Cyfra21-1 elevated.Pathological type is positively correlated with KRAS gene mutation,ECOG score and Cyfra21-1 are negatively correlated with KRAS gene mutation.