不同EGFR突变状态晚期肺腺癌患者TKI治疗效果比较  

Comparison of curative effect of TKI on different EGFR mutation status patients with advanced lung adenocarcinoma

作　　者：梁淑芳[1] 郭晔[1] 马克威[1] 

机构地区：[1]吉林大学第一医院肿瘤中心,吉林长春130021

出　　处：《吉林大学学报（医学版）》2014年第2期404-408,共5页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金资助课题(81372870)

摘　　要：目的:比较表皮生长因子酪氨酸激酶抑制剂(EGFR-TKI)在功能状态(PS)评分为2的晚期肺腺癌表皮生长因子(EGFR)突变状态未明但具备突变"优势"临床特征患者和EGFR突变阳性患者中一线治疗疗效的差异,探讨是否可应用突变"优势"临床特征指导EGFR-TKI治疗。方法:回顾性分析70例ⅢB/Ⅳ期、PS评分为2、一线口服EGFR-TKI治疗的肺腺癌患者的临床资料,其中EGFR突变阳性患者35例,EGFR突变状态未明但具备突变"优势"临床特征患者35例。均采用口服靶向药物进行治疗。Kaplan-Meier法描述2组患者生存曲线,2组患者的中位无进展生存期(PFS)、总生存期(OS)和生存率比较采用Log-rank检验。结果:EGFR突变阳性患者总体中位PFS为8.2个月,EGFR突变状态未明但具备突变"优势"临床特征患者中位PFS为6.3个月,组间比较差异有统计学意义(P=0.043);EGFR突变阳性患者总体中位OS为17.1个月,EGFR突变状态未明但具备突变"优势"临床特征患者中位OS为9.4个月,组间比较差异有统计学意义(P=0.044);EGFR突变阳性患者1年、2年生存率为57.1%和31.4%,EGFR突变状态未明但具备突变"优势"临床特征患者1年、2年生存率为37.1%和20.0%,EGFR突变阳性患者1年及2年生存率均高于EGFR突变状态未明但具备突变"优势"临床特征患者(P=0.047,P=0.049);分层因素分析,女性(P=0.003)、年龄>60岁(P=0.048)、无吸烟史(P=0.012)和临床分期为Ⅳ期(P=0.049)的EGFR突变阳性患者的中位PFS明显高于EGFR突变状态未明但具备突变"优势"临床特征患者。结论:PS评分为2的肺腺癌患者一线选用TKI治疗时,EGFR突变阳性患者治疗疗效明显优于EGFR突变状态未明但具备突变"优势"临床特征患者;女性、年龄>60岁、无吸烟史和临床分期为Ⅳ期是影响2组患者中位PFS差异的重要因素。Objective To compare the clinical effects of epidermal growth factor receptor tyrosine kinase inhibitors （FGFR-TKI） between the advanced lung adenocarcinoma patients with unknown epidermal growth factor receptor （EGFR） mutation status and mutation advantage whose performance status（P$） score was 2 and the patients with postive EGFR mutation, and to explore wether the clinical features of mutation advantage can guide the TKI treatment or not. Methods 70 lung adenocarcinoma patients＇ clinical data, who were confirmed Ⅲ B-Ⅳ stage, PS score was 2, and treated with first-line TKI therapy, were analyzed retrospectivly. There were 35 cases of positive ECJFR mutation and 35 cases of unknown EGFR mutation status but with mutation advantage. Kaplan-Meier method was used to draw the survival curve and Log-rank test was used to analyze the progression-free survival （PFS）, overall survival（OS）, and survival rates of the patients in two groups. Results The median PFS of positive EGFR mutation patients was 8.2 months, and it was 6.3 months in the patients with EGFR unknown mutation status but with mutation advantage. There was significant difference of the median PFS between two groups （P= 0. 043） ; the median OS of the positive EGFR mutation patients was 17.1 months, and it was 9.4 months in the patients with unknown EGFR mutation status but with mutation advantage. There was significant difference of the median OS between two groups （P = 0. 044） ; 1-year and 2-year survival rates of the positive EGFR mutation patients were 57.1% and 31.4%, and they were 37.1% and 20.0% in the patients with unknown EGFR mutation status but with mutation advantage. There was significant difference of the survival rate between two groups （P= 0. 047, P= 0. 049）; the subgroup analysis results showed that the median PFS of the female （P= 0. 003）, 60 years （P=0. 048）, without smoking history （P=0. 012）, and clinical stage Ⅳ （P=0. 049） patients in positive EGFR mutation group were higher than th

关 键 词：肺肿瘤 表皮生长因子 表皮生长因子酪氨酸激酶抑制剂 无进展生存期 总生存期 

分 类 号：R734.2[医药卫生—肿瘤]