TÌNH TRẠNG ĐỘT BIẾN EGFR, KRAS CỦA UNG THƯ BIỂU MÔ TUYẾN PHỔI VÀ MỘT SỐ YẾU TỐ LIÊN QUAN: NGHIÊN CỨU CẮT NGANG TẠI BỆNH VIỆN PHỔI TRUNG ƯƠNG

Abstract

Lung adenocarcinoma is the most common subtype of non-small cell lung cancer (NSCLC), exhibiting significant heterogeneity in both histopathologic patterns and molecular alterations. Among these, EGFR and KRAS mutations are pivotal biomarkers guiding targeted and individualized therapy. Objective: To evaluate the histopathologic features and their associations with EGFR, KRAS mutations, including correlations with TTF‑1 and PD‑L1 expression, in patients with lung adenocarcinoma at the Vietnam National Lung Hospital. Methods: This cross-sectional study included 211 patients diagnosed with lung adenocarcinoma from August 2022 to March 2024. Histologic classification was based on WHO 2021 criteria; EGFR, KRAS mutation status were collected and analyzed using descriptive and comparative statistics (chi-square test). Results: The most common histologic subtypes were acinar (37.9%), papillary (30.3%), and solid (17.1%). The prevalence of EGFR mutations was 39.3%, mainly consisting of exon 19 deletions (45.8%) and L858R exon 21 substitutions (38.6%). EGFR-mutant cases were found across most histologic subtypes, showed a high rate of TTF-1 positivity (89.2%), and were predominantly PD-L1 negative or expressed at low levels (PD-L1 ≥ 50% accounted for only 10.8%). The prevalence of KRAS mutations was 17.5%, with G12C accounting for 86.5%. KRAS mutations were significantly associated with male sex, age over 60, smoking history, and high PD-L1 expression (≥ 50%). They were detected in multiple histologic subtypes, most frequently in acinar and papillary, but no significant differences were observed between subtypes. Conclusion: EGFR and KRAS mutations are associated with distinct histologic and immunologic profiles. EGFR mutations were more common in well-differentiated subtypes, with high TTF‑1 and low PD‑L1 expression, while KRAS mutations—particularly G12C—were linked to smoking, male sex, and high PD‑L1.Integrating histopathologic, immunohistochemical, and molecular data is essential for optimizing personalized treatment strategies in NSCLC.