Wang Feng, Fang Ping, Hou Dan-Yang, Leng Zai-Jun, Cao Le-Jie
Department of Respiratory Disease, Tongling People's Hospital, Tongling, China E-mail :
Asian Pac J Cancer Prev. 2014;15(11):4493-7. doi: 10.7314/apjcp.2014.15.11.4493.
Epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) can predict the clinical response to tyrosine kinase inhibitor (TKI) therapy. However, EGFR mutations may be different in primary tumors (PT) and metastatic lymph nodes (MLN). The aim of this study was to compare EGFR mutations between PT and the corresponding MLN in NSCLC patients, and provide some guidelines for clinical treatment using TKI therapy.
A systematic review and meta-analysis was performed with several research databases. Relative risk (RR) with the 95% confidence interval (CI) were used to investigate the EGFR mutation status between PT and the corresponding MLN. A random-effects model was used.
9 publications involving 707 patients were included in the analysis. It was found that activation of EGFR mutations identified in PT and the corresponding MLN was 26.4% (187/707) and 19.9% (141/707), respectively. The overall discordance rate in our meta-analysis was 12.2% (86/707). The relative risk (RR) for EGFR mutation in PT relative to MLN was 1.33 (95%CI: 1.10-1.60; random-effects model). There was no significant heterogeneity between the studies (I2=5%, p=0.003).
There exists a considerable degree of EGFR mutation discrepancy in NSCLC between PT and corresponding MLN, suggesting that tumor heterogeneity might arise at the molecular level during the process of metastasis.
非小细胞肺癌（NSCLC）中的表皮生长因子受体（EGFR）突变可预测对酪氨酸激酶抑制剂（TKI）治疗的临床反应。然而，EGFR突变在原发性肿瘤（PT）和转移性淋巴结（MLN）中可能有所不同。本研究的目的是比较NSCLC患者PT和相应MLN之间的EGFR突变情况，并为使用TKI治疗的临床治疗提供一些指导。
对多个研究数据库进行系统评价和荟萃分析。采用95%置信区间（CI）的相对风险（RR）来研究PT和相应MLN之间的EGFR突变状态。使用随机效应模型。
分析纳入了9篇涉及707例患者的文献。结果发现，PT和相应MLN中鉴定出的EGFR突变激活率分别为26.4%（187/707）和19.9%（141/707）。我们的荟萃分析中的总体不一致率为12.2%（86/707）。PT中EGFR突变相对于MLN的相对风险（RR）为1.33（95%CI：1.10 - 1.60；随机效应模型）。各研究之间无显著异质性（I2 = 5%，p = 0.003）。
NSCLC中PT和相应MLN之间存在相当程度的EGFR突变差异，提示在转移过程中可能在分子水平出现肿瘤异质性。
