单纯靶向或靶向联合治疗晚期EGFR 21 L858R突变肺腺癌患者的生存分析  

Survival analysis of patients with advanced EGFR 21 L858R lung adenocarcinoma treated with targeted therapy alone or in combination with targeted therapy

作　　者：何姣 韩志刚[1] 俞婷婷[1] HE Jiao;HAN Zhigang;YU Tingting(The Third Affiliated Hospital of Xinjiang Medical University,Xinjiang Urumqi 830011,China)

机构地区：[1]新疆医科大学第三附属医院,新疆乌鲁木齐830011

出　　处：《现代肿瘤医学》2023年第23期4362-4366,共5页Journal of Modern Oncology

基　　金：新疆维吾尔自治区自然科学基金资助项目(编号:2022D01C522)。

摘　　要：目的:评价真实世界晚期EGFR 21 L858R突变肺腺癌患者单纯靶向或靶向联合治疗的疗效及安全性差异,分析影响无进展生存期(PFS)及总生存期(OS)的因素。方法:回顾性分析2015年01月至2019年12月在我院确诊的109例晚期EGFR 21 L858R突变肺腺癌患者的临床特征、治疗疗效、安全性及生存数据,采用SPSS 26.0软件进行统计分析。结果:靶向联合治疗组的中位PFS及中位OS明显优于单纯靶向治疗组(mPFS:14.5个月vs 10.3个月,P<0.05;mOS:31.9个月vs 24.6个月,P<0.05),两组患者ORR(54.4%vs 38.5%)及DCR(96.5%vs 94.2%)无统计学差异,但靶向联合治疗在一定程度提高了患者ORR,显示出较好的客观缓解率。对患者基线资料分析发现,初治时肿瘤大小、治疗方式、治疗前癌胚抗原(CEA)及细胞角质素19(CYFRA21-1)水平是疾病进展的独立预后因素,而年龄、初治时有无脑转移、治疗方式、糖类抗原125(CA125)及细胞角质素19(CYFRA21-1)水平均可影响患者的OS。安全性比较中发现,单纯靶向治疗最常见的不良反应为皮疹,其次是消化道反应;靶向联合治疗最常见不良反应为消化道反应,其次是骨髓抑制。总体而言,两组患者耐受性良好,但靶向联合治疗组不良反应发生率(68.4%)明显高于单纯靶向治疗组(38.5%),差异有统计学意义(P<0.001)。结论:晚期肺腺癌EGFR 21 L858R突变患者使用靶向联合治疗的疗效要优于单纯靶向治疗,且耐受性良好。初治时肿瘤大小、治疗前肿瘤相关抗原(CEA及CYFRA21-1)水平是PFS的独立预后因素,年龄、初治时有无脑转移、肿瘤相关抗原(CYFRA21-1、CA125)水平均可影响患者的OS。Objective:To evaluate the efficacy and safety differences between targeted alone or targeted combination therapy in real-world patients with advanced EGFR 21 L858R lung adenocarcinoma and to analyze the factors affecting progression-free survival(PFS)and overall survival(OS).Methods:The clinical characteristics,treatment effects,safety and survival data of 109 patients with advanced EGFR 21 L858R lung adenocarcinoma diagnosed in our hospital from January 2015 to December 2019 were retrospectively analyzed using SPSS 26.0 software.Results:Median PFS and median OS were significantly better in the targeted combination therapy group than in the targeted therapy alone group(mPFS:14.5 months vs 10.3 months,P<0.05,mOS:31.9 months vs 24.6 months,P<0.05).There was no statistically significant difference in ORR(54.4%vs 38.5%)and DCR(96.5%vs 94.2%)between the two groups,but the targeted combination therapy improved the ORR of patients to some extent and showed a better objective remission rate.Analysis of patients'baseline data revealed that tumor size at initial treatment,treatment modality,pre-treatment carcinoembryonic antigen(CEA)and cytokeratin 19(CYFRA21-1)levels were independent prognostic factors for disease progression,while age,presence of brain metastases at initial treatment,treatment modality,glycoantigen 125(CA125)and cytokeratin 19(CYFRA21-1)levels could affect patients'OS.In a safety comparison,the most common adverse effect of targeted therapy alone was rash,followed by gastrointestinal reactions.The most common adverse effect of targeted combination therapy was gastrointestinal reaction,followed by bone marrow suppression.Overall,the two groups were well tolerated,but the incidence of adverse reactions in the targeted combination therapy group(68.4%)was significantly higher than that in the targeted therapy alone group(38.5%),and the difference was statistically significant(P<0.001).Conclusion:Patients with advanced lung adenocarcinoma with EGFR 21 L858R mutation were better treated with targeted combinati

关 键 词：真实世界研究 肺腺癌 L858R突变 靶向治疗 预后 

分 类 号：R734.2[医药卫生—肿瘤]