表皮生长因子受体突变和肺腺癌组织学亚型的预后价值
The epidermal growth factor receptor (EGFR) mutation status has become one of the most important factors in the treatment of non-small cell lung cancer. However, the relationship between EGFR mutation and the histologic subtype of lung adenocarcinoma remains to be fully elucidated. We examined the relationship between the predominant subtype of adenocarcinoma and the prognosis and investigated the correlation between a new subtype of adenocarcinoma and EGFR mutations. This study included 182 patients with adenocarcinoma who underwent complete resection. The rate of EGFR mutation-positive patients was significantly higher among female patients, never smokers, patients with small tumors (< 3 cm in size), patients with well-differentiated tumors, and patients with a pStage I classification. The rates of adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and lepidic-predominant subtype were high in male EGFR mutation-positive patients. The prevalence of the acinar and papillary-predominant subtypes was high among EGFR mutation-positive female patients, as was AIS, MIA, and the lepidic-predominant subtype. The progression-free survival (PFS) of the EGFR mutation-positive patients was significantly better than that of the EGFR mutation-negative patients (75.8 vs 67.1%, p = 0.03). However, the multivariate analysis of clinicopathologic and histologic factors did not reveal the prognostic impact of the EGFR mutation status on PFS. The overall survival (OS) of the EGFR mutation-positive patients was significantly better than that of the EGFR mutation-negative patients (93.7 vs 63.4%, p < 0.01). However, in the multivariate analysis the EGFR mutation status was not significantly associated with OS.表皮生长因子受体（EGFR）突变状态已成为非小细胞肺癌治疗中最重要的因素之一。然而，EGFR突变与肺腺癌组织学亚型之间的关系仍有待充分阐明。我们研究了腺癌的主要亚型与预后的关系并探讨了一种新的腺癌亚型与EGFR突变之间的关系。本研究包括182例接受完全切除的腺癌患者。EGFR突变阳性患者的比例在女性、从不吸烟者、小肿瘤（<3 cm）、高分化肿瘤以及病理学分期Ⅰ期的患者中显著更高。在男性EGFR突变阳性患者中，原位腺癌（AIS）、微浸润腺癌（MIA）和贴壁型为主亚型的发生率较高。在EGFR突变阳性女性患者中，腺泡型和乳头状为主亚型的比例高，就像AIS、MIA和贴壁型为主亚型在男性中那样。EGFR突变阳性患者的无进展生存期（PFS）明显优于EGFR突变阴性患者（75.8个月对67.1个月，p = 0.03）。但是，临床病理和组织学因素的多变量分析未揭示EGFR突变状态对PFS的预后影响。EGFR突变阳性患者的总生存期（OS）显著优于EGFR突变阴性患者（93.7个月对63.4个月，p <0.01）。然而，在多变量分析中，EGFR突变状态与OS无显著相关性。 感谢楼主分享，论坛里的网友们估计更加关心应对方案，现在针对EGFR的靶向方案还是不少的，免疫之类的方案也在不断研究，希望多谢专业性的文章介绍研究成果，祝福楼主家和大家都新年好运！
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