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卵巢癌是女性生殖系统中最常见的恶性肿瘤,其起病隐匿, 确诊时多已是晚期且预后较差[1],大约90%的病例属于上皮性卵巢癌,最常见的是高级别浆液性癌。与其他恶性肿瘤相同,上皮性卵巢癌的发生是一个将正常细胞推向恶性状态的过程,可能涉及基因突变[2-3]。近年来较多研究指出BRCA1和BRCA2基因是卵巢癌的发病遗传因素[4]。随着近两年卵巢癌维持治疗的新探索,BRCA1/2基因检测变得尤为重要,并且2020年NCCN指南中提出了完善BRCA1/2检测将有益于卵巢癌整个一线治疗模式的选择。但病人的BRCA1/2基因状态与病人的临床病理特征有无密切的联系,需要更进一步探索。本研究收集我院2018年1月至2019年1月就诊的上皮性卵巢癌病人共70例进行BRCA1/2基因检测,查看突变情况,并根据检测结果将病人分为致病突变组和对照组,基于SPSS22.0分析2组病人的临床病理特征有无差异。现作报道。
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70例上皮性卵巢癌病人中,出现BRCA1/2基因致病性突变的病人共计20例,总占比28.5%。BRCA1突变16例占22.85%(16/70),BRCA2突变4例占5.71%(4/70)。其中移码突变12例,无义突变8例。外显子11突变8例占40%,在BRCA1中11号外显子突变7例,其中2例为981-982位删除AT后出现一个终止密码子,翻译终止(序号6),2例1504-1508位删除TTAAA后,502位的L(亮氨酸)突变为A(丙氨酸),并在突变位点之后2个氨基酸处终止翻译(序号11),1例2138位的C(半胱氨酸)突变为G(丙氨酸),并形成了终止密码,翻译终止(序号11),2例为c.4801A>T的无义突变(序号14)。在BRCA2中11号外显子突变1例,为4065-4068位删除TACC后,1355位的N(天冬氨酸)突变为K(赖氨酸),并在突变位点之后10个氨基酸处终止翻译(序号10)。临床数据表明,在BRCA1/2突变的病人中,BRCA1基因中11号外显子突变频率较高,该外显子或许是一个潜在的突变热点区域。20种BRCA1、BRCA2基因致病突变情况见表 1及图 1~4。
序号 突变位置 碱基序列变化 氨基酸改变 突变类型 例数 1 BRCA1外显子21 c.5503C>T p.R1835* 无义突变 1 2 BRCA2外显子23 c.9097_9098insA p.T3033Nfs*11 移码突变 1 3 BRCA1外显子24 c.5470_5477del8 p.I1824Dfs*3 移码突变 1 4 BRCA1外显子22 c.5353C>T p.Q1785*5 无义突变 1 5 BRCA2外显子24 c.5470_5477del8 p.I1824Dfs*3 移码突变 1 6 BRCA1外显子11 c.981_982delAT p.C328*10 无义突变 2 7 BRCA2外显子14 c.7389_7392delTCAA p.N2463Kfs*3 移码突变 1 8 BRCA1外显子15 c.4503C>A p.C1501* 无义突变 1 9 BRCA1外显子7 c.335delA p.N112Ifs*7 移码突变 2 10 BRCA2外显子11 c.4065_4068delTCAA p.N1355Kfs*10 移码突变 1 11 BRCA1外显子11 c.1504_1508delTTAAA p.L502Afs*2 移码突变 2 12 BRCA1外显子11 c.2138C>G p.S713* 无义突变 1 13 BRCA1外显子24 c.5521delA p.S1841Vfs*2 移码突变 1 14 BRCA1外显子11 c.4801A>T p.K1601* 无义突变 2 15 BRCA1外显子7 c.335delA p.N112Ifs*7 移码突变 2 表 1 20例上皮性卵巢癌病人BRCA1/2基因致病突变情况
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研究结果发现BRCA1/2致病性突变组高级别浆液性乳头状癌发生率、对铂类治疗药物敏感率、有家族史率均高于未突变组(P < 0.05~P < 0.01),2组年龄和临床分期比较差异无统计学意义(P>0.05)(见表 2)。
临床病理特征 n BRCA1/2突变(n=20) BRCA1/2未突变(n=50) χ2 P 年龄(x±s)/岁 70 50.25±7.11 52.08±11.16 0.82* >0.05 病理类型 高浆
非高浆44
2618
226
248.84 < 0.01 铂类药物 敏感
耐药59
1113
746
45.96 < 0.05 家族史 有
无16
549
117
436.13 < 0.05 临床分期 Ⅰ~Ⅱ
Ⅲ~Ⅳ31
397
1324
260.98 >0.05 *示t′值 表 2 BRCA1/2致病变异与未变异病人临床病理特征的比较
BRCA1/2基因突变与上皮性卵巢癌病人临床病理特征的关系
Analysis of the relationship between BRCA1/2 gene mutation and clinicopathological characteristics of epithelial ovarian cancer
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摘要:
目的 探究BRCA1/2突变与上皮性卵巢癌病人的临床病理特征关系。 方法对70例经病理确诊的上皮性卵巢癌病人进行BRCA基因检测,分析卵巢癌病人BRCA1/2突变情况,并分析BRCA1/2基因突变与卵巢癌病人的临床病理特征包括年龄、临床分期、病理类型、家族遗传性、铂类药物敏感性的关系。 结果70例上皮性卵巢癌病人中,20例存在BRCA1/2致病性突变,占28.5%,其中BRCA1 16例,BRCA2 4例;BRCA1/2致病性突变组高级别浆液性乳头状癌发生率、对铂类治疗药物敏感率、有家族史率均高于未突变组(P < 0.05~P < 0.01),2组年龄和临床分期比较差异无统计学意义(P>0.05)。 结论BRCA1/2突变的上皮性卵巢癌病人易复发、恶性程度较高,但对铂类药物敏感,BRC1/2基因突变的上皮性卵巢癌病人具有家族遗传性。 Abstract:ObjectiveTo explore the relationship between BRCA1/2 mutation and clinicopathological features of epithelial ovarian cancer. MethodsThe BRCA gene in 70 patients with epithelial ovarian cancer diagnosed by pathology was detected, the BRCA1/2 mutation was analyzed, and the relationship between BRCA1/2 mutation and clinicopathogical characterloistics of ovarian cancer patients(including age, clinical stage, pathological type, familial inheritance and platinum drug sensitivity) was analyzed. ResultsAmong 70 patients with epithelial ovarian cancer, 20 cases with BRCA1/2 gene mutation were found(accounting for 28.5%), which included 16 cases with BRCA1/2 gene mutation and 4 cases with BRCA2 gene mutation.The incidence rate of high-grade papillary carcinoma, susceptibility to platinum therapy and family history in BRCA1/2 mutation group were higher than those in non-mutation group(P < 0.05 to P < 0.01), but there was no statistical significance in the age and clinical stage between two groups(P>0.05). ConclusionsThe epithelial ovarian cancer with BRCA1/2 mutation is prone to recurrence, high grade malignancy, and sensitive to platinum drugs.The BRCA1/2 gene mutation in epithelial ovarian cancer patients is related to the family genetic history of the patients. -
Key words:
- epithelial ovarian neoplasms /
- BRCA1/2 /
- gene mutation
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表 1 20例上皮性卵巢癌病人BRCA1/2基因致病突变情况
序号 突变位置 碱基序列变化 氨基酸改变 突变类型 例数 1 BRCA1外显子21 c.5503C>T p.R1835* 无义突变 1 2 BRCA2外显子23 c.9097_9098insA p.T3033Nfs*11 移码突变 1 3 BRCA1外显子24 c.5470_5477del8 p.I1824Dfs*3 移码突变 1 4 BRCA1外显子22 c.5353C>T p.Q1785*5 无义突变 1 5 BRCA2外显子24 c.5470_5477del8 p.I1824Dfs*3 移码突变 1 6 BRCA1外显子11 c.981_982delAT p.C328*10 无义突变 2 7 BRCA2外显子14 c.7389_7392delTCAA p.N2463Kfs*3 移码突变 1 8 BRCA1外显子15 c.4503C>A p.C1501* 无义突变 1 9 BRCA1外显子7 c.335delA p.N112Ifs*7 移码突变 2 10 BRCA2外显子11 c.4065_4068delTCAA p.N1355Kfs*10 移码突变 1 11 BRCA1外显子11 c.1504_1508delTTAAA p.L502Afs*2 移码突变 2 12 BRCA1外显子11 c.2138C>G p.S713* 无义突变 1 13 BRCA1外显子24 c.5521delA p.S1841Vfs*2 移码突变 1 14 BRCA1外显子11 c.4801A>T p.K1601* 无义突变 2 15 BRCA1外显子7 c.335delA p.N112Ifs*7 移码突变 2 表 2 BRCA1/2致病变异与未变异病人临床病理特征的比较
临床病理特征 n BRCA1/2突变(n=20) BRCA1/2未突变(n=50) χ2 P 年龄(x±s)/岁 70 50.25±7.11 52.08±11.16 0.82* >0.05 病理类型 高浆
非高浆44
2618
226
248.84 < 0.01 铂类药物 敏感
耐药59
1113
746
45.96 < 0.05 家族史 有
无16
549
117
436.13 < 0.05 临床分期 Ⅰ~Ⅱ
Ⅲ~Ⅳ31
397
1324
260.98 >0.05 *示t′值 -
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