Parvar Seyedeh Yasamin, Rezvani Alireza, Ghaderpanah Rezvan, Hefzosseheh Mohammadhossein, Rafiei Shakila, Monabati Ahmad
Student Research Committee Shiraz University of Medical Sciences Shiraz Iran.
Department of internal medicine, Autophagy Research Center Shiraz University of Medical Science Shiraz Iran.
Health Sci Rep. 2023 Jul 5;6(7):e1369. doi: 10.1002/hsr2.1369. eCollection 2023 Jul.
Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancer cases, with smoking being a critical risk factor. The identification of NSCLC patients harboring epidermal growth factor receptor (EGFR) mutations, sensitized to tyrosine kinase inhibitors, has revolutionized treatment plans, resulting in improved clinical responses and reduced chemotherapy toxicity. This study aimed to assess the relationship between EGFR mutations and smoking patterns in patients diagnosed with lung adenocarcinoma referred to major pathologic laboratories.
This cross-sectional study included 217 NSCLC patients aged above 18 years. Molecular abnormalities of the EGFR gene were analyzed by polymerase chain reaction amplification of exons 18-21 accompanied by Sanger sequencing. Then, the data were analyzed using the SPSS 26 software. Logistic regression analysis, test, and Mann-Whitney test were used to evaluate the relation between EGFR mutations and smoking patterns.
EGFR mutations were identified in 25.3% of patients, predominantly involving deletion in exon 19 (61.8%). For most of the mutant EGFR patients, the majority were nonsmokers (81.8%), and 52.7% were female patients. Besides, the median duration of smoking was 26 years and the median frequency of smoking was 23 pack-years in the mutant EGFR group, both of which were lower compared to the wild mutant group. Moreover, female gender, current, and heavy smoking were significantly correlated with EGFR mutations based on the univariate logistic regression analysis (: 0.004, 0.005, and 0.001, respectively).
Female gender and nonsmoker status were strongly associated with positive EGFR mutations. While guidelines traditionally recommended EGFR testing primarily for female nonsmokers with advanced NSCLC, our study in line with the recently published evidence has shown a significant prevalence of positive EGFR mutations among male patients and smokers. Therefore, routine mutation testing is suggested for all NSCLC patients. Considering the limited access to EGFR testing laboratories in developing countries, the results of such epidemiological surveys can assist oncologists in choosing the most suitable treatment plan.
非小细胞肺癌（NSCLC）占肺癌病例的85%，吸烟是一个关键危险因素。识别携带表皮生长因子受体（EGFR）突变且对酪氨酸激酶抑制剂敏感的NSCLC患者，彻底改变了治疗方案，提高了临床反应并降低了化疗毒性。本研究旨在评估在主要病理实验室就诊的肺腺癌患者中EGFR突变与吸烟模式之间的关系。
这项横断面研究纳入了217名年龄在18岁以上的NSCLC患者。通过对18 - 21外显子进行聚合酶链反应扩增并结合桑格测序来分析EGFR基因的分子异常。然后，使用SPSS 26软件对数据进行分析。采用逻辑回归分析、卡方检验和曼 - 惠特尼U检验来评估EGFR突变与吸烟模式之间的关系。
25.3%的患者检测到EGFR突变，主要为19外显子缺失（61.8%）。在大多数突变型EGFR患者中，大多数为非吸烟者（81.8%），且52.7%为女性患者。此外，突变型EGFR组的中位吸烟时长为26年，中位吸烟频率为23包年，两者均低于野生型组。而且，基于单因素逻辑回归分析，女性性别、当前吸烟和重度吸烟与EGFR突变显著相关（分别为：0.004、0.005和0.001）。
女性性别和非吸烟状态与EGFR突变阳性密切相关。虽然传统指南主要推荐对晚期NSCLC的女性非吸烟者进行EGFR检测，但我们的研究与最近发表的证据一致，显示男性患者和吸烟者中EGFR突变阳性的患病率也很高。因此，建议对所有NSCLC患者进行常规突变检测。考虑到发展中国家EGFR检测实验室的可及性有限，此类流行病学调查结果可帮助肿瘤学家选择最合适的治疗方案。
