晚期非小细胞肺癌患者使用EGFR-TKI治疗后长期生存的研究  

Preliminary Study of long term survival of advanced non-small cell lung cancer patients treated with EGFR-TKI

作　　者：管慧[1] 李龙芸[1] 王孟昭[1] 王树兰[1] 韩如冰[1] 钟巍[1] 冉然 周京伟[1] 郑直[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸科,北京100730 [2]中国医学科学院基础医学研究所,北京100005

出　　处：《癌症进展》2011年第5期561-568,共8页Oncology Progress

摘　　要：目的探索应用表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)治疗晚期非小细胞肺癌(NSCLC)患者长期生存的影响因素,并研究长期生存者与EGFR突变关系。方法回顾性分析2002年12月至2007年6月在北京协和医院进行EGFR-TKI治疗的292例晚期NSCLC,并收集长期生存(定义为使用吉非替尼或厄洛替尼治疗后生存时间≥3年)患者详细临床资料,对其中部分生存的患者进行血清EGFR检测,也收集长期或非长期生存患者中已检测过的EGFR突变数据。结果 EGFR-TKI治疗晚期NSCLC≥3年生存率18.5%。非吸烟史(P=0.039)和病理类型(腺癌)(P=0.004)是EGFR-TKI治疗后长期生存密切相关的因素。长期生存患者EGFR敏感突变率66.7%,非长期生存者为57.1%。获得疾病控制者中66%有EGFR敏感突变,长期生存者59.3%于18个月左右疾病进展,如能再给予合适治疗,对生存有明显延长益处。结论 EGFR-TKI是有效的治疗晚期NSCLC的靶向药物,可以明显延长NSCLC患者的生存时间。EGFR敏感突变可能作为EGFR-TKI治疗疗效预测指标,但不能作为长期生存的预后指标。对EG-FR-TKI治疗失败者,应研究其疾病进展的关键分子生物学改变,试探继续不断地治疗,使肺癌真正成为慢性疾病。Objective To investigate the impact of epidermal growth factor receptor-tyrosine kinase inhibitor （EGFR-TKI） as well as EGFR mutaionl status on long term survival of advanced non-small cell lung cancer （NSCLC） pa- tients. Methods We retrospectively analyzed the clinical information of 292 advanced NSCLC patients who underwent EGFR-TKI therapy in Peking Union Medical College Hospital from December 2002 to June 2007. EGFR nmtation data were collected and analyzed whenever available EGFR mutations in a subset of long term survivors （defined as ≥ 3 years after treatment with Gefitinib or Erlotinib） were also determined in serum by DNA sequencing. Clinical data were statistically analyzed by Pearson＇s Chi-square test. Results Long term survival rate for advanced NSCLC patients treated with EGFR- TKI was 18.5% , and significantly correlated with non-smoking history （P = 0. 039 ） , and adenocarcinoma histopathology （P = 0. 004）. EGFR mutation rate in long and short-term （less than 3 years） survival patients were 66. 7% and 57.1% , respectively （P = 0. 56）. 66% of stable disease （SD） patients showed EGFR mutation. Conclusions EGFR-TKI is an effective targeted therapeutic drug for advanced NSCLC patients and significantly prolongs survival time. EGFR mutation can help predict EGFR-TKI therapeutic efficacy, but not indicate prognosis of long term survival.

关 键 词：非小细胞肺癌 表皮生长因子受体 靶向治疗 

分 类 号：R734.2[医药卫生—肿瘤]