Napsin A表达与培美曲塞联合铂类二线治疗表皮生长因子受体突变肺腺癌患者疗效和预后的关系  

Correlation of Napsin A expression with efficacy and prognosis of pemetrexed combined with platinum in second-line treatment of lung adenocarcinoma with epidermal growth factor receptor mutation

作　　者：程兰兰 陈君平 吕东来 徐军 CHENG Lanlan;CHEN Junping;LYU Donglai;XU Jun(Department of Pathology,the 901st Hospital of the Joint Logistics Support Force of PLA,Hefei 230031,Anhui,China;First Department of Oncology,the 901st Hospital of the Joint Logistics Support Force of PLA,Hefei 230031,Anhui,China)

机构地区：[1]解放军联勤保障部队第九〇一医院病理科,合肥230031 [2]解放军联勤保障部队第九〇一医院肿瘤一科,合肥230031

出　　处：《癌症进展》2023年第16期1762-1766,1774,共6页Oncology Progress

基　　金：第九〇一医院科研项目(2021YGZD02)。

摘　　要：目的探讨Napsin A表达与培美曲塞联合铂类二线治疗表皮生长因子受体(EGFR)突变肺腺癌患者疗效和预后的关系。方法分析64例接受培美曲塞联合铂类二线治疗的EGFR突变肺腺癌患者的临床资料,采用免疫组化法检测Napsin A的表达情况,分析Napsin A表达与患者疗效及预后的关系。结果64例患者中,Napsin A阳性表达率为73.4%。国际肺癌研究协会(IASLC)分级为Ⅰ或Ⅱ级的肺腺癌患者肺腺癌组织中Napsin A阳性表达率明显高于IASLC分级为Ⅲ级的患者,差异有统计学意义(P﹤0.01)。女性患者客观缓解率(ORR)高于男性患者,Napsin A阳性患者疾病控制率(DCR)高于Napsin A阴性患者,差异均有统计学意义(P﹤0.05)。Napsin A阳性、联合贝伐珠单抗治疗、无继发T790M突变均是EGFR突变肺腺癌患者接受培美曲塞联合铂类二线治疗后无进展生存期(PFS)的保护因素。Napsin A阳性、联合贝伐珠单抗治疗、无继发T790M突变患者的中位PFS均优于Napsin A阴性、未联合贝伐珠单抗治疗、继发T790M突变患者(P﹤0.05)。多因素分析结果显示,Napsin A阳性是EGFR突变肺腺癌患者接受培美曲塞联合铂类二线治疗后总生存期(OS)的保护因素。Napsin A阳性患者中位OS明显优于Napsin A阴性患者(P﹤0.01)。结论对于一代EGFR-酪氨酸激酶抑制剂(TKI)耐药、接受培美曲塞联合铂类二线治疗的患者,联合使用贝伐珠单抗、无继发T790M突变患者的PFS更优,Napsin A是预测二线治疗疗效和患者预后的分子标志物。Objective To investigate the correlation of Napsin A expression with efficacy and prognosis of pemetrexed combined with platinum in second-line treatment of lung adenocarcinoma with epidermal growth factor receptor(EGFR)mutation.Method Clinical data of 64 lung adenocarcinoma patients with EGFR mutation who were treated with pemetrexed+platinum were analyzed,Napsin A expression was measured by immunohistochemistry,and the correlation of Napsin A expression with efficacy and prognosis of patients were anlayzed.Result The positive expression rate of Napsin A was 73.4%in 64 patients,and the positive expression rate of Napsin A in lung adenocarcinoma tissues of lung adenocarcinoma patients with International Association for the Study of Lung Cancer(IASLC)grade I or II was higher than those with grade III(P<0.01).The objective response rate(ORR)was higher in female than male patients,and the disease control rate(DCR)in Napsin A positive patients was higher than that in negative patients(P<0.05).Positive Napsin A,combined bevacizumab treatment,and no T790M mutation were protective factors of progression-free survival(PFS)after pemetrexed+platinum second-line treatment of lung adenocarcinoma patients with EGFR mutation.The median PFS in patients with positive Napsin A,combined bevacizumab treatment,and no T790M mutation were better than those with negative Napsin A,non-bevacizumab treatment,and T790M mutation(P<0.05).Multivariate analysis showed that positive Napsin A was the protective factors of overall survival(OS)after pemetrexed+platinum second-line treatment of lung adenocarcinoma with EGFR mutation.The median OS of patients with positive Napsin A was better than that with negative Napsin A(P<0.01).Conclusion For patients with second-line pemetrexed+platinum treatment after EGFR-tyrosine kinase inhibitor(TKI)failure,PFS is superior in patients with non-bevacizumab treatment or without the T790M mutation,and Napsin A is a molecular marker to predict the efficacy of chemotherapy and prognosis of patients.

关 键 词：肺腺癌 Napsin A 表皮生长因子受体 培美曲塞 预后 

分 类 号：R734.2[医药卫生—肿瘤]