Department of Pathology, R.D. Gardi Medical College, Ujjain, India.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Asian Pac J Cancer Prev. 2023 Jun 1;24(6):1855-1861. doi: 10.31557/APJCP.2023.24.6.1855.
Lung malignancy is one of the most common neoplasms worldwide. Accurate histology sub-typing and identification of gene mutations in lung tumours are considered important to administer targeted therapy for improved clinical outcome. Our aim is to determine the frequency of EGFR mutation and Programmed death ligand-1 (PD -L1) status of lung malignancies in patients attending a rural hospital in Central India.
Formalin-fixed histology diagnosed lung malignancy (n=99) bronchoscopic/trucut lung biopsies were identified and the tissue blocks and slides were retrieved. Histology typing and staging of the lesions was assessed. PD-L1 expression on biopsy was detected by immunohistochemistry using commercially available primary antibody. PD-L1 expression was assessed and semi-quantified based on the intensity and proportion of tumour cells stained for the marker. EGFR gene mutation at exon19 and 21 was detected by polymerase chain reaction of tissue from paraffin blocks. Final analysis was performed on 87 biopsies for status of EGFR mutation and PD-L1 expression.
The average age of lung malignancies patients was 63 years, with a preponderance of males. Advance disease in stage III and stage IV was more common in squamous cell carcinoma as compared to adenocarcinoma (p < 0.01). Mutations at exon 19-21 of the EGFR gene were detected in 7/87 (8%) cases of adenocarcinoma and all of these patients were non-smokers. A total of 52.9% of biopsies showed PD-L1 expression, which was higher in adenocarcinoma patients (p=0.04), smokers (p=0.00), and stage II and III patients (p= 0.00).
EGFR gene mutations at exon 19 or 21 are seen in lung adenocarcinoma cases. PD-L1 expression was observed in EGFR mutated tissues. Our results should be further validated with large sample size and multicenter clinical data before extrapolation to design immunotherapy strategies.
肺癌是全球最常见的恶性肿瘤之一。准确的组织学亚型分类和肺癌肿瘤基因突变的鉴定被认为对实施靶向治疗以改善临床预后非常重要。我们的目的是确定在印度中部一家农村医院就诊的肺癌患者中 EGFR 突变和程序性死亡配体-1（PD-L1）状态的频率。
确定并检索了经福尔马林固定的组织学诊断为肺癌（n=99）的支气管镜/经支气管肺活检组织块和切片。评估了病变的组织学分型和分期。使用市售的原发性抗体通过免疫组织化学检测活检组织中 PD-L1 的表达。根据标记物染色的肿瘤细胞的强度和比例评估 PD-L1 表达并进行半定量。使用来自石蜡块的组织通过聚合酶链反应检测 EGFR 基因外显子 19 和 21 的突变。最终分析了 87 例活检标本的 EGFR 突变和 PD-L1 表达状态。
肺癌患者的平均年龄为 63 岁，男性居多。与腺癌相比，Ⅲ期和Ⅳ期进展期的鳞状细胞癌更为常见（p<0.01）。在 87 例腺癌中，有 7 例（8%）检测到 EGFR 基因外显子 19-21 的突变，所有这些患者均为非吸烟者。共有 52.9%的活检标本显示 PD-L1 表达，腺癌患者（p=0.04）、吸烟者（p=0.00）和Ⅱ期和Ⅲ期患者（p=0.00）的表达更高。
在肺腺癌病例中观察到 EGFR 基因外显子 19 或 21 的突变。在 EGFR 突变组织中观察到 PD-L1 表达。在推广到设计免疫治疗策略之前，应该用更大的样本量和多中心临床数据进一步验证我们的结果。
