表皮生长因子受体突变型进展期肺腺癌的临床特点及经TKIs单药治疗后无进展生存期影响因素  

Clinical characteristics of advanced lung adenocarcinoma with EGFR mutation and influencing factors of progression-free survival after TKIs monotherapy

作　　者：杨淑慧 周琳 李银珍 杜日昌 YANG Shuhui;ZHOU Lin;LI Yinzhen;DU Richang(Yue Bei People’s Hospital Affiliated to Shantou University Medical College,Shaoguan 512025,China)

机构地区：[1]汕头大学医学院附属粤北人民医院,广东韶关512025

出　　处：《山东医药》2021年第12期5-9,共5页Shandong Medical Journal

基　　金：2019年韶关市卫生计生科研计划项目(Y19038);广东省医学科学技术研究基金项目(B2019221)。

摘　　要：目的总结表皮生长因子受体(EGFR)突变型进展期肺腺癌的临床特点,分析经一代酪氨酸激酶抑制剂(TKIs)单药治疗后无进展生存期(PFS)的影响因素。方法收集328例不可切除的进展期肺腺癌患者驱动基因检测信息、临床资料,比较EGFR突变及野生型患者的临床特征;采用Cox回归分析经TKIs单药治疗后PFS的影响因素。结果纳入EGFR突变型患者162例,野生型患者166例,突变型患者在女性(53.1%vs.24.1%,P<0.001)、不吸烟患者(72.1%vs.52.4%,P<0.001)多见。尽管野生型与突变型肺癌均以周围型肺癌多见(92.0%vs.83.7%),但中央型肺癌在野生型占比较高(8.0%vs.16.3%,P=0.023)。EGFR突变型患者肺(58.6%vs.39.8%,P=0.001)、脑(35.8%vs.21.7%,P=0.005)、骨(53.7%vs.29.5%,P<0.001)、胸膜转移(48.8%vs.27.7%,P<0.001)多见,就诊时常存在两个或以上器官转移(71.0%vs.48.8%,P<0.001)。经TKI单药治疗的143例EGFR突变型患者中位PFS11个月,多因素分析显示骨转移(HR 1.77,95%CI:1.17~2.68,P<0.05)、多器官转移(HR 1.39,95%CI:1.22~1.59,P<0.05)与PFS独立相关。结论EGFR突变型进展期肺腺癌易出现肺、脑、骨、胸膜转移,就诊时常有多器官转移;骨转移及转移器官数目是影响患者接受TKIs治疗预后的独立因素。Objective To summarize the clinical characteristics of epidermal growth factor receptor(EGFR)mutated advanced lung adenocarcinoma,and to analyze the influencing factors of progression-free survival(PFS)after monotherapy with first-generation tyrosine kinase inhibitors(TKIs).Methods The driver gene detection information and clinical data of 328 patients with unresectable advanced lung adenocarcinoma were collected,and we compared the clinical characteristics between patients with EGFR positive mutation and wild-type EGFR.Cox regression was used to analyze the influencing factors of PFS after TKIs monotherapy.Results This study included 162 patients with EGFR positive mutation and 166 patients with wild-type EGFR.EGFR positive mutation was more common in females(53.1%vs.24.1%,P<0.001)and non-smokers(72.1%vs.52.4%,P<0.001).Although peripheral lung cancer was more common in both wildtype EGFK and mutant lung cancer(92.0%vs.83.7%),central lung cancer accounted for a higher proportion in wild type EGFR(8.0%vs.16.3%,P=0,023).Patients with EGFR positive mutation were more likely to have pulmonary metastasis(58.6%vs.39.8%,P=0.001),brain metastasis(35.8%vs.21.7%,P=0.005),bone metastasis(53.7%vs.29.5%,P<0.001)and pleural metastasis(48.8%vs.27.7%,P<0.001).Two or more organ metastases were frequently present(71.0%vs.48.8%,P<0.001).The median PFS of 143 patients with EGFR positive mutation treated with TKIs monotherapy were 11 months.Multivariate analysis showed that bone metastases(HR 1.77,95%CI:1.17-2.68,P<0.05)and multiple organ metastases(HR 1.39,95%CI:1.22-1.59,P<0.05)were associated with independence of PFS.Conclusions Pulmonary metastasis,brain metastasis,bone metastasis and pleural metastasis are common in mutant lung adenocarcinoma patients,and multiple organ metastasis often presents at visit.Bone metastases and the number of metastatic organs are independent factors affecting the prognosis of patients receiving TKIs treatment.

关 键 词：肺腺癌 表皮生长因子受体 酪氨酸激酶抑制剂 无进展生存期 骨转移 多器官转移 

分 类 号：R734.2[医药卫生—肿瘤]