国际肿瘤学杂志

国际肿瘤学杂志 ›› 2018, Vol. 45 ›› Issue (1): 10-.doi: 10.3760/cma.j.issn.1673-422X.2018.01.003

• 论著 • 上一篇    下一篇

晚期NSCLC患者恶性胸腔积液中上清和细胞 沉淀EGFR基因突变状态的比较

李慧,严时,刘岩,柳影,马丽霞,刘显红,程颖   

  1. 130012 长春，吉林省肿瘤医院转化医学实验室（李慧、严时、刘岩、程颖），胸部肿瘤内科（柳影、马丽霞、 刘显红、程颖）
  • 出版日期:2018-01-08 发布日期:2018-02-12
  • 通讯作者: 程颖 E-mail:jl.cheng@163.com
  • 基金资助:
    吉林省卫生计生委科研项目（2014Z016、2014Z018）

Comparison of EGFR mutation between supernatant and pellets of malignant pleural effusion from patients with advanced nonsmall cell lung cancer

Li Hui*, Yan Shi, Liu Yan, Liu Ying, Ma Lixia, Liu Xianhong, Cheng Ying   

  1. Medical Oncology Translational Research Laboratory, Jilin Cancer Hospital, Changchun 130012, China
  • Online:2018-01-08 Published:2018-02-12
  • Contact: Cheng Ying E-mail:jl.cheng@163.com
  • Supported by:
    Scientific Research Project of Jilin Provincial Health and Family Planning Commission (2014Z016, 2014Z018)

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摘要： 目的比较晚期非小细胞肺癌（NSCLC）患者恶性胸腔积液（MPE）中上清和细胞沉淀检测表皮生长因子受体（EGFR）基因突变的结果差异，为临床精确检测提供依据。方法连续收集386例晚期NSCLC患者MPE标本（实验组202例，验证组184例）。实验组根据MPE中肿瘤细胞含量将标本分为4组：无细胞组（n=77）、（1～5）×104个/ml细胞组（n=43）、（6～10）×104个/ml细胞组（n=52）和＞10×104个/ml细胞组（n=30），采用扩增阻滞突变系统（ARMS)分别对同一个标本的上清和细胞沉淀进行EGFR基因突变检测，并对比两组EGFR基因突变的阳性检测率。在验证组中只检测上清或细胞沉淀来验证已建立的方法。结果实验组总EGFR基因突变率为30.7%（62/202）。无细胞组上清标本中EGFR突变率（37.6%）高于沉淀标本（33.8%）；（1～5）×104个/ml和（6～10）×104个/ml细胞组上清和沉淀标本EGFR基因突变率相同（分别为25.6%和21.1%），但两种标本之间存在基因突变不一致现象；＞10×104个/ml细胞组中两种标本EGFR基因突变率相同（33.3%），突变一致率为100%。在184例验证标本中，上清标本EGFR突变率为32.7%（36/110），细胞沉淀标本EGFR突变率为32.4%（24/74），差异无统计学意义（χ2=0.02，P=0.97）。结论无肿瘤细胞的晚期NSCLC患者MPE也可用于EGFR基因突变检测，MPE标本具有异质性，无细胞上清和细胞沉淀中EGFR基因突变存在差异，应根据患者MPE中肿瘤细胞数量和性质进行病理评估后选择最佳标本进行基因检测，提高阳性检测率。

关键词: 胸腔积液, 恶性； 受体, 表皮生长因子； 突变

Abstract: ObjectiveTo compare the epidermal growth factor receptor (EGFR) mutation differences between supernatant and pellets of malignant pleural effusion (MPE) in advanced nonsmall cell lung cancer (NSCLC) patients and provide the evidence for clinical accurate detection. MethodsA total of 386 consecutive MPE specimens were collected in the study (202 in experimental group and 184 in validation group). Specimens in experimental group were divided into 4 groups depending on tumors cell concentration in the samples: zero cell (n=77), (15)×104/ml cells (n=43), (610)×104/ml cells (n=52) and >10×104/ml cells group (n=30). Amplification refractory mutation system (ARMS) was performed to detect EGFR gene mutation in supernatant and pellets of each individual case respectively, and the EGFR mutation positive rates were compared between the two groups. EGFR mutation test was carried out using either supernatant or pellets in validation group to verify the established method. ResultsIn the experimental group, the total EGFR mutation positive rate was 30.7% (62/202). In the zero cell group, EGFR mutation positive rate was higher in supernatant than that in pellets (37.6% vs. 33.8%). In the (15)×104/ml cells group and (610)×104/ml cells group, EGFR mutation positive rate was equal but not concordant between supernatant and pellets (25.6% and 21.1% respectively). In the >10×104/ml cells group, EGFR mutation positive rate was equal (33.3%) with 100% concordance between supernatant and pellets. In the validation group (n=184), EGFR mutation rate was 32.7% (36/110) in supernatant and 32.4% (24/74) in pellets, and there was no statistical significance (χ2=0.02, P=0.97). ConclusionTumor cell free MPE specimens from patients with advanced NSCLC are suitable for EGFR mutation test. Heterogeneity of MPE results in difference with respect to EGFR gene mutation status between cellfree supernatant and pellet. Pathological evaluation based on the quantity and quality of tumor cells in MPE patients prior to test and optional samples selection are necessary to increase EGFR mutation positive rate.

Key words: Pleural effusion, malignant, Receptor, epidermal growth factor, Mutation