Correlation Between Genetic Mutation Types And Clinicopathological Features Of Lung Adenocarcinoma And Its Effect On Prognosis

purpose:1.Analysis of the distribution of gene mutations in lung adenocarcinoma patients;2.Explore the correlation between different gene mutation types and clinicopathological characteristics;3.To analyze the impact of different gene mutation types on patient prognosis and the risk factors of lung adenocarcinoma patients.Methods: collected from July 2017 to December 2020 in yan’an university affiliated hospital by pathology or histology diagnosis of lung cancer by the second generation sequencing(NGS)18 gene patients with a total of 223 cases,except 37 cases of non-adenocarcinoma patients(including small cell lung cancer,squamous carcinoma,large cell carcinoma,etc.),186 cases of lung adenocarcinoma,according to the standard,except for clinical pathological data imperfect patients 58 cases,a total of 128 patients.Based on the collected data,the correlation between gene mutations and clinicopathological characteristics of lung adenocarcinoma patients is analyzed by chi-square test;all included patients are followed for 2 years,and the final observed study endpoint is disease progression or death.The Kaplan-Meier method obtains the progression-free survival time and 2-year progression-free survival rate,and the Log-rank test selects the risk factors that may affect the prognosis of lung adenocarcinoma.Risk factors associated with the prognosis of lung adenocarcinoma are included into the COX proportional risk model.The Kaplan-Meier method analyzes the effect of lung adenocarcinoma mutations on patient outcome,the Log-rank test compares survival between groups,and P<0.05 is considered statistically significant.Results:1.In 128 lung adenocarcinoma,the multi-gene coexisting mutation rate is41.21%,with the most EGFR/TP53 co-mutations(21.09%).The highest EGFR mutation rate,the EGFR mutation rate in 128 lung adenocarcinoma is 70.31%,TP53 41.41%,ALK 8.59%,KRAS 7.81%,ERBB2 7.03%,RET 5.47%,BRAF 4.69%,and PIK3CA4.69%.2.EGFR mutation shows statistically significant differences between large groups of differentiation grade and lesion diameter,ALK mutation is statistically different between age groups,TP53 mutation in gender,differentiation grade,TNM stage and pleural depression sign at initial diagnosis,ERBB2 mutation shows significant differences between differentiated grade groups,PIK3 CA mutation shows statistically significant differences between lesion location and lesion trait groups(p<0.05).3.RET,KRAS,and BRAF mutation show no significant differences in differentiation grade,lesion diameter,gender,age,smoking history,family history,TNM stage at initial diagnosis,lobation and burr,void features,pleural depression,necrosis,lesion location,and lesion traits(p>0.05).4.EGFR mutation and EGFR/TP53 co-mutation show significant differences in tumor stage,differentiation grade and lesion diameter(P<0.05).Patients with EGFR mutation is mostly seen in stage I and highly differentiated adenocarcinoma,EGFR/TP53co-mutation is more found in stage IV and poorly differentiated adenocarcinoma,and EGFR mutation is smaller than patients with EGFR/TP53 co-mutation.5.Two-year survival results of gender,age,smoking history,tumor stage,differentiation grade,lesion diameter,lesion characteristics,and treatment methods affect the prognosis of lung adenocarcinoma(P<0.05);the results of multivariate analysis show that treatment method is an independent risk factor related to the prognosis of lung adenocarcinoma patients(P<0.05).ALK,BRAF,EGFR,PIK3 CA,and RET mutation show no obvious correlation with prognosis(P>0.05);ERBB2,KRAS,and TP53 mutation have some correlation with prognosis(P<0.05),which may be associated with poor prognosis in patients with lung adenocarcinoma.6.There is no significant prognosis difference between the groups with EGFR,ALK,TP53,and KRAS mutation(P>0.05).There is a significant difference between the EGFR single mutation and EGFR/TP53 co-mutation groups(P=0.040),and the EGFR/TP53co-mutation is worse than the single EGFR mutation.Conclusion:1.The multi-gene coexisting mutation rate in lung adenocarcinoma is 41.21%,with the highest mutation rate for EGFR/TP53 co-mutation.The EGFR,ALK,TP53,and KRAS gene have a high mutation rate in lung adenocarcinoma.2.Different gene mutations have specific clinicopathological features,EGFR mutation is more common in patients with high,moderate differentiation and small lesion diameter,ALK mutation in patients aged 29-39 and 59-69 years,and TP 53 mutations in men with poorly differentiated adenocarcinoma,late tumor stage,and patients with pleural depression,ERBB2 mutation is mostly found in poorly differentiated adenocarcinoma,and it is recommended for lung adenocarcinoma patients in the middle lung with soft tissue imaging of the right lung.3.EGFR mutation shows earlier tumor stage,higher differentiation grade,and smaller lesion diameter compared with EGFR/TP53 co-mutation.There are no significant differences in the various clinicopathological characteristics between the EGFR,ALK,TP53,and KRAS gene mutation groups.4.Sex,age,smoking history,tumor stage,differentiation grade,lesion diameter,lesion traits,and treatment mode affect the prognosis of lung adenocarcinoma,and treatment mode is an independent risk factor related to the prognosis of lung adenocarcinoma.5.Mutations in ERBB2,KRAS,and TP53 gene are associated with poor prognosis in patients,and EGFR/TP53 co-mutation have a worse prognosis than the EGFR mutation.Clear gene mutation can predict the prognosis of patients with lung adenocarcinoma,and it is of great significance for the standardized diagnosis and treatment and individualized treatment of patients with lung adenocarcinoma.