表皮生长因子受体蛋白结构图，图片来自维基共享资源。
人们长期就怀疑肺结核病(tuberculosis)会增加一个人患肺癌的风险，因为肺部炎症和纤维化能够诱导基因损伤。然而，特异性基因变化和疾病的直接证据一直没有广泛地报道过。
发表在国际肺癌协会2012年2月那期Journal of Thoracic Oncology杂志上的研究表明肺结核病与表皮生长因子受体(epidermal growth factor receptor, EGFR)---一种在非小细胞肺癌(non-small cell lung cancer)中发现的基因突变类型---突变存在关联。研究人员下结论道，在肺腺癌(lung adenocarcinoma)病人中肺结核病和EGFR突变存在关联。腺癌是最为常见的肺癌。
研究人员在1999年6月到2011年1月期间研究了275名病人。在这些病人当中，191名发生EGFR突变。他们的发现表明“旧有的肺结核病和瘢痕癌(scar cancer，译者注：临床上一种特殊类型的肺癌与肺结核有关，多为肺腺癌)跟EGFR突变，特别是第19个外显子缺失，存在统计学上显著性的关联”，其中这个外显子缺失是最为常见的肿瘤EGFR突变形式。
在东亚地区，比如中国台湾，人们发现较高的肿瘤EGFR突变发生率(incidence)，就像肺结核菌感染的盛行率(prevalence)一样。好消息是发生EGFR突变的肿瘤当用EGFR-酪氨酸激酶抑制物治疗时有75%的反应率(response rate)。根据该项研究，这可能是为什么“(当进行药物治疗后)那些遭受旧有肺结核病损伤的病人若发生EGFR突变或者说它的外显子发生突变要比那些没有发生突变的病人存活更长时间”。(生物谷：towersimper编译)
doi:10.1097/JTO.0b013e31823c588d
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PMID:
Association between Tumor Epidermal Growth Factor Receptor Mutation and Pulmonary Tuberculosis in Patients with Adenocarcinoma of the Lungs
Luo, Yung-Hung; Wu, Chieh-Hung; Wu, Wen-Shuo; Huang, Chu-Yun; Su, Wei-Juin; Tsai, Chun-Ming; Lee, Yu-Chin; Perng, Reury-Perng; Chen, Yuh-Min
Background: The possible association between pulmonary tuberculosis (TB) and lung cancer development has been studied for several decades. However, the association between epidermal growth factor receptor (EGFR) mutation status and pulmonary TB in patients with adenocarcinoma of the lungs is unknown.
Methods: We reviewed the data of our patients with adenocarcinoma of the lungs who had a clinical history of pulmonary TB or old TB lesions shown on chest computed tomography scan and evaluated the association between tumor EGFR mutation status and pulmonary TB.
Results: From June 1999 to January 2011, there were 275 patients with pulmonary adenocarcinoma with tumor EGFR mutation data available for analysis. Of them, 191 patients had EGFR mutations, 17 had a clinical history of pulmonary TB infection, 72 had old TB lesions on chest computed tomography scans, and 14 had scar cancer. Patients with old TB lesions had a higher incidence of EGFR mutation than those without (p = 0.018). Exon 19 deletions occurred more frequently in patients with old TB lesions than in patients without (p < 0.001). Those patients with old TB lesions who had EGFR mutations or exon 19 mutations survived longer than those who did not (p = 0.014 and 0.001, respectively). Patients with exon 19 deletions and old TB lesions showed no survival difference compared with those with exon 19 deletions and without old TB lesions (p = 0.271).
Conclusions: Patients with pulmonary adenocarcinoma who had scar cancer or had old TB lesions had a higher probability of having EGFR mutations, especially exon 19 deletions.
