表皮生长因子受体突变与肿瘤标记物在晚期非小细胞肺癌靶向治疗中意义及相关性分析  

Value and association of epidermal growth factor receptor mutations and tumor markers in advanced non-small cell lung cancer patients with target therapy

作　　者：华云旗[1] 毋永娟[1] 杨永岩[1] 杨燕霞[1] 谭亚琴[1] 孟令茹[1] 袁晓荣 刘丽萍[1] 金云剑 

机构地区：[1]包头市肿瘤医院肿瘤内科一病区,内蒙古包头014030

出　　处：《临床荟萃》2012年第16期1381-1385,1388,共6页Clinical Focus

基　　金：包头市医药卫生项目(Wjj20110512)

摘　　要：目的非小细胞肺癌(non-small cell lung cancer,NSCLC)约占肺癌总数的80%。本研究拟观察表皮生长因子受体(EGFR)基因突变和肿瘤标记物癌抗原125(CA125)与角蛋白19片段(CYFRA21-1)在表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)治疗晚期NSCLC患者中的意义及其之间的相关性,探讨晚期NSCLC靶向治疗疗效评价指标及预后相关因子。方法自2008年1月至2011年8月间,我院肿瘤内科收治的晚期NSCLC患者74例,依据方案分为化疗组和靶向治疗组。化疗组:以顺铂为基础的联合化疗(吉西他滨1 000mg/m2第1,8天;多西他赛75mg/m2,第1天;长春瑞滨30mg/m2第1,8天+顺铂80mg/m2第1天),21天为1个周期;靶向治疗组:吉非替尼250mg/d,或者厄洛替尼150mg/d,餐后2小时口服。比较化疗组与靶向治疗组治疗前后CA125、CYFRA21-1变化。靶向治疗组依据是否接受基因检测分为突变组和未检测组,分别记录靶向治疗组中EGFR突变患者与未检测患者的临床疗效,同时统计两组接受靶向治疗后肿瘤标记物CA125、CYFRA21-1降低率,以及靶向治疗患者EGFR突变与临床疗效关系及与标记物的相关性。结果靶向治疗后肿瘤标记物CA125与CYFRA21-1分别为(33.96±7.03)kU/L和(4.02±1.76)μg/L,与治疗前比较均明显降低(P<0.05);化疗组治疗后肿瘤标记物CA125与CYFRA21-1分别为(36.24±6.03)kU/L和(3.80±1.35)μg/L,与治疗前比较也均明显降低(P<0.05)。EGFR突变患者疾病控制率为84.2%(16/19),明显高于EGFR突变未检测患者(P<0.05);在EGFR突变患者经靶向治疗是肿瘤标记物CA125和CYFRA21-1降低率分别为89.5%(17/19)和47.4%(9/19),均明显高于EGFR突变未检测组,差异有统计学意义(P<0.05)。结论基因突变的晚期NSCLC患者EGFR-TKI靶向治疗临床疗效好;在EGFR-TKI靶向治疗过程中有一定比例的患者肿瘤标记物CA125和CYFRA21-1均有降低,且EGFR基因突变的患者接受靶向治疗后CA125、CYFRA21-1降低人数比率更高,CA125、CYFRA21-1变化�Objective Non-small cell lung cancer（NSCLC） accounted for about 80% of the total number of lung cancer.This study observed the significance and the correlation between epidermal growth factor receptor（EGFR） gene mutations and tumor markers CA125 and CYFRA21-1 in treatment of advanced NSCLC with tyrosine kinase inhibitor,and explored the efficacy and prognosis-related factors of advanced NSCLC with targeted therapy.Methods From January 2008 to August 2011,our department admitted 74 patients with advanced NSCLC,according to the therapy plan,the patients were divided into two groups：chemotherapy group and targeted therapy group.Chemotherapy group：the basis of cisplatin combination chemotherapy included（gemcitabine 1 000 mg/m2 d1,8 or docetax 75 mg/m2 d1,vinorelbine 30 mg/m2 d1,8＋cisplatin 80 mg/m2 d1）,21 days for a cycle;targeted therapy group：gefitinib：250 mg/d,or erlotinib：150 mg/d,two hours after a meal orally.The markers of CYFRA21-1 and CA125 were observed before and after treatment in chemotherapy group and targeted therapy group.Targeted therapy group was divided into mutations group and not test group,and the clinical curative effects of the two groups were recorded,while the lower rates of CA125,CYFRA21-1 after targeted therapy in two groups were documented,the clinical effect of EGFR mutations and the relationship between markers were analyzed.Results After treatment,the markers of CYFRA21-1 and CA125 were（33.96±7.03） kU/L and（4.02±1.76） μg/L in targeted therapy group,（36.24±6.03） kU/L and（3.80±1.35） μg/L in chemotherapy group,they were reduced significantly after targeted therapy and chemotherapy（P〈0.05）;The disease control rate of EGFR mutations group was 84.2%（16/19）,higher than not test group,the difference was statistically significant（P〈0.05）;The reduction rates of the tumor marker CA125 and CYFRA21-1 in EGFR mutations group were 89.5%（17/19） and 47.4%（9/19）,which were higher than those of not test group（P〈0.05）.Conclusion Th

关 键 词：癌 非小细胞肺 受体 表皮生长因子 癌胚抗原 角蛋质类 抗肿瘤联合化疗方案 聚合酶链反应 免疫毒素类 

分 类 号：R734.2[医药卫生—肿瘤]