引用本文:汤 誉,张 萍,王敏捷,蓝佳琦,林炳棋.SMARCA4缺失型非小细胞肺癌患者的临床病理特征及预后影响因素分析[J].中国临床新医学,2024,17(3):283-288.
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SMARCA4缺失型非小细胞肺癌患者的临床病理特征及预后影响因素分析
汤 誉1,张 萍2,王敏捷1,蓝佳琦3,林炳棋1
1.联勤保障部队第九〇九医院(厦门大学附属东南医院)呼吸内科,漳州 363000;2.联勤保障部队第九〇九医院(厦门大学附属东南医院)肿瘤内科,漳州 363000;3.漳州市医院肿瘤科,福建 363099
摘要:
[摘要] 目的 分析SMARCA4缺失型非小细胞肺癌(NSCLC)患者的临床病理特征及预后影响因素。方法 回顾性分析2016年1月至2021年6月厦门大学附属东南医院和漳州市医院收治的106例SMARCA4缺失型NSCLC患者(SMARCA4缺失组)和212例非SMARCA4缺失型NSCLC患者(非SMARCA4缺失组)的临床资料。采用Kaplan-Meier法绘制生存曲线,组间比较采用log-rank检验。采用Cox回归分析影响SMARCA4缺失型NSCLC患者2年总生存期的因素。结果 与非SMARCA4缺失组比较,SMARCA4缺失组患者年龄更大,男性和吸烟史比例更高,肿瘤直径更长,Ki-67指数更高,EGFR突变比例更低,鳞状细胞癌比例更低,低分化癌比例更高,差异有统计学意义(P<0.05)。SMARCA4缺失型NSCLC患者中,95.28%(101/106)患者BRG1蛋白完全缺失,8.20%(5/61)患者CK7阴性,85.11%(80/94)患者CK5/6阴性,77.36%(82/106)患者TTF-1阴性,80.19%(85/106)患者P40阴性,66.67%(16/24)患者CD34阴性,56.52%(13/23)患者SALL4阴性。非SMARCA4缺失组2年生存情况优于SMARCA4缺失组(log-rank检验: χ2=126.837,P<0.001)。男性、年龄增长、有吸烟史和较长的肿瘤直径是缩短SMARCA4缺失型NSCLC患者生存时间的独立危险因素。结论 SMARCA4缺失型NSCLC是一种不同于非SMARCA4缺失型NSCLC的肿瘤,患者预后较差,肿瘤侵袭性高。
关键词:  SMARCA4  基因突变  肺癌  临床病理特征  预后
DOI:10.3969/j.issn.1674-3806.2024.03.08
分类号:R 734.2
基金项目:福建省卫生健康科研人才培养项目(编号:2019-ZQN-13)
Analysis on clinicopathological features and prognostic influencing factors of SMARCA4-deficient non-small-cell lung cancer patients
TANG Yu1, ZHANG Ping2, WANG Minjie1, LAN Jiaqi3, LIN Bingqi1
1.Department of Respiratory Medicine, the 909th Hospital of the Joint Logistics Support Force(Dongnan Hospital of Xiamen University), Zhangzhou 363000, China; 2.Department of Internal Medicine-Oncology, the 909th Hospital of the Joint Logistics Support Force(Dongnan Hospital of Xiamen University), Zhangzhou 363000, China; 3.Department of Oncology, Zhangzhou Municipal Hospital of Fujian Province, Fujian 363099, China
Abstract:
[Abstract] Objective To analyze the clinicopathological features and prognostic influencing factors of SMARCA4-deficient non-small-cell lung cancer(NSCLC) patients. Methods The clinical data of 106 patients with SMARCA4-deficient NSCLC(SMARCA4-deficient group) and 212 patients with non-SMARCA4-deficient NSCLC(non-SMARCA4-deficient group) who were admitted to Dongnan Hospital of Xiamen University and Zhangzhou Municipal Hospital of Fujian Province from January 2016 to June 2021 were retrospectively analyzed. Survival curve was plotted by Kaplan-Meier method, and comparison between groups was performed by log-rank test. Cox regression was used to analyze the factors influencing the 2-year overall survival of the SMARCA4-deficient NSCLC patients. Results Compared with those in the non-SMARCA4-deficient group, the patients in the SMARCA4-deficient group had older age, higher proportion of male and smoking history, longer tumor diameter, higher Ki-67 index, lower proportion of EGFR mutation, lower proportion of squamous cell carcinoma, and higher proportion of poorly differentiated carcinoma, and the differences were statistically significant(P<0.05). Among patients with SMARCA4-deficient NSCLC, 95.28%(101/106) of the patients had complete deficiency of BRG1 protein, and 8.20%(5/61) of the patients were CK7-negative, and 85.11%(80/94) of the patients were CK5/6 -negative, and 77.36%(82/106) of the patients were TTF-1 -negative, and 80.19%(85/106) of the patients were P40-negative, and 66.67%(16/24) of the patients were CD34 -negative, and 56.52%(13/23) of the patients were SALL4-negative.The 2-year survival of the patients with non-SMARCA4-deficient NSCLC was better than that of the patients with SMARCA4-deficient NSCLC(log-rank test: χ2=126.837, P<0.001). Male gender, increase of age, having smoking history, and longer tumor diameter were independent risk factors for shortening the survival time of the SMARCA4-deficient NSCLC patients. Conclusion SMARCA4-deficient NSCLC is a type of tumor that differs from non-SMARCA4-deficient NSCLC in that it has a poorer prognosis and a higher tumor aggressiveness.
Key words:  SMARCA4  Gene mutation  Lung cancer  Clinicopathological features  Prognosis