表皮生长因子受体基因扩增在非小细胞肺癌预后中作用的meta分析  

The Association between EGFR Gene Amplification and the Prognosis in Non-small Cell Lung Cancer:A meta-analysis

作　　者：王志杰[1] 杨鹭[1] 安彤同[1] 赵军[1] 白桦[1] 段建春[1] 吴梅娜[1] 卓明磊[1] 王玉艳[1] 王洁[1] 

机构地区：[1]恶性肿瘤发病机制及转化研究教育部重点实验室,北京大学临床肿瘤学院暨北京肿瘤防治研究所,北京肿瘤医院胸部肿瘤内科

出　　处：《中国肺癌杂志》2009年第12期1247-1254,共8页Chinese Journal of Lung Cancer

摘　　要：背景与目的研究表明探讨表皮生长因子受体(epidermal growth factor receptor,EGFR)基因扩增与非小细胞肺癌预后的可能相关,但各研究结论不一。本研究通过meta分析,评价了EGFR基因扩增在不同人种以及不同治疗情况下的预后意义。方法检索PubMed、Cochrane图书馆以及CNKI中文数据库中研究细胞EGFR基因扩增与非小细胞肺癌预后关系的文献,根据欧洲肺癌工作组提供的专门的评分标准对纳入的文献进行质量评估,收集每个文献的风险比(hazard ratio,HR)及95%可信区间(confidence interval,CI),应用meta分析对文献进行定量综合分析。结果共入选17篇文献,应用表皮生长因子受体-酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosinekinase inhibitor,EGFR-TKI)治疗的12项研究共入选病例1221例,结果显示扩增阳性患者预后优于扩增阴性患者(HR=0.82,95%CI:0.68-0.99,P=0.04);欧美人种基因扩增阳性对EGFR-TKI疗效有明显的预测作用(HR=0.42,95%CI:0.31-0.57,P<0.001)。未应用EGFR-TKI治疗的8项研究共入选病例658例,结果显示扩增阳性与阴性患者死亡风险相当(HR=1.14,P=0.12);其中亚洲人中基因扩增者较未扩增者预后差(HR=1.88,95%CI:1.21-2.93,P=0.005)。结论EGFR基因扩增在欧美人中可能是EGFR-TKI治疗的阳性疗效预测指标,对于亚洲人预测意义不明显。另外,在未接受EGFR-TKI治疗的亚洲人中,EGFR基因扩增阳性者预后较差。Background and objective Many studies concluded that epidermal growth factor receptor （EGFR） gene amplification might be related with the prognosis in non-small cell lung cancer.However,the results were not consistent.To identify whether EGFR gene amplification could affect the prognosis,a meta-analysis was conducted based on the published works.Methods According to inclusion and exclusion criteria,articles were selected from medical electronic databases searching,including PubMed,Cochrane library and CNKI.The qualities of included articles were scored based on the European Lung Cancer Working Party scale,and the hazard ratio （HR） and the 95% confidence interval （CI） were also collected.Meta-analysis was completed using software Review Manager 4.2.Results Forest plot from 12 studies in which 1 221 included patients were all treated with EGFR-TKI showed that the prognosis of patients harboring EGFR gene amplification were superior to negative ones （HR=0.82,95%CI：0.68-0.99,P=0.04）,and for Caucasian patients who received EGFR-TKI,the survivals were longer in EGFR gene amplification positive cases than those without amplification （HR=0.42,95%CI：0.31-0.57,P〈0.001）.Meta results from 8 studies in which 658 included patients did not receive EGFR-TKI indicated that the casualty hazard of amplification positive patients was comparable with negative ones.However,for Asia patients who failed to receive EGFR-TKI,the prognosis of patients with EGFR gene amplification were inferior to negative ones （HR=1.88,95%CI：1.21-2.93,P=0.005）.Conclusion EGFR gene amplification may be a positive predictive factor in terms of survival for Caucasian patients receiving EGFR-TKI rather than Asia patients.However,the prognosis was inferior in Asia patients with EGFR amplification to those without the amplification,if they failed to receive EGFR-TKI.

关 键 词：表皮生长因子受体 肺肿瘤 预后 META分析 

分 类 号：R734.2[医药卫生—肿瘤]