KRAS突变晚期肺腺癌患者一线治疗的回顾性观察研究  

Retrospective observation of first-line treatment in patients with advanced lung adenocarcinoma with KRAS mutation

作　　者：李莹莹 詹丽芬 吴登鹏 周继光 黄源茂 吴雯 林小燕 LI Yingying;ZHAN Lifen;WU Dengpeng;ZHOU Jiguang;HUANG Yuanmao;WU Wen;LIN Xiaoyan(Department of Oncology,Zhangzhou Affiliated Hospital of Fujian Medical University,Fujian Province,Zhangzhou 363000,China;Department of Internal Medicine ICU,Zhangzhou Affiliated Hospital of Fujian Medical University,Fujian Province,Zhangzhou 363000,China;Department of Statistics,Zhangzhou Affiliated Hospital of Fujian Medical University,Fujian Province,Zhangzhou 363000,China;Department of Pharmacy,Zhangzhou Affiliated Hospital of Fujian Medical University,Fujian Province,Zhangzhou 363000,China)

机构地区：[1]福建医科大学附属漳州市医院肿瘤内科,福建漳州363000 [2]福建医科大学附属漳州市医院内科ICU,福建漳州363000 [3]福建医科大学附属漳州市医院统计室,福建漳州363000 [4]福建医科大学附属漳州市医院药学部,福建漳州363000

出　　处：《中国当代医药》2023年第36期99-103,111,F0003,F0004,共8页China Modern Medicine

基　　金：福建省科技计划项目(2019Y9032)。

摘　　要：目的 KRAS突变基因普遍存在于非小细胞肺癌(NSCLC)中,回顾性分析真实世界中KRAS突变的局晚期/晚期肺腺癌患者一线治疗的结果。方法 选取2018年1月至2021年12月福建医科大学附属漳州市医院诊断为KRAS突变与野生的局晚期/晚期肺腺癌的患者作为研究对象,从中选取接受过至少1个疗程的一线治疗方案的患者,分析治疗的相关特征、分子谱、在真实世界中不同治疗方式对此类患者总生存期(OS)和无进展生存期(PFS)的影响。结果 根据纳入排除标准收集92例KRAS突变与164例KRAS野生型晚期肺腺癌患者,KRAS组中位年龄64岁,95.7%为男性,91.3%为吸烟患者,二代测序结果中51.5%为KRAS G12C亚型组,48.5%为non-G12C亚型组。生存分析中KRAS突变组与野生组的中位PFS比较(5.2个月vs.6.8个月,P=0.22),差异有统计学意义;在亚型分组中,G12C组和nonG 12C组的中位总生存期(mO S)比较(11.5个月vs.6.35个月,P=0.12),差异有统计学意义。在5种治疗分组中,在KRAS突变组与G12C组应用含抗血管生成药物治疗OS最长(单化疗vs.抗血管药物vs.含免疫治疗vs.三药联合组vs.中成药:9.0个月vs.20.0个月vs.10.0个月vs.15.0个月vs.2.0个月,P<0.001),差异有统计学意义。三药联合组的治疗反应率最高,并且在nonG 12C组生存时间最长(mO S尚未达到)。结论 KRAS基因突变较野生型患者预后较差,其中G12C亚型生存预后对比non-G12C组较好。KRAS基因突变患者对于抗血管药物和免疫治疗药物联合治疗效果好。本研究为KRAS突变的局部晚期/晚期肺腺癌一线治疗的生存结局和最优治疗方案选择提供了有用的证据。Objective To retrospectively analyze first-line treatment outcomes in real-world patients with advanced/advanced lung adenocarcinoma with KRAS mutation,which is prevalent in non-small cell lung cancer(NSCLC).Methods Patients diagnosed with KRAS mutation and wild advanced/advanced lung adenocarcinoma in Zhangzhou Affiliated Hospital of Fujian Medical University from January 2018 to December 2021 were selected as study subjects,and patients who had received at least one course of first-line treatment were selected.Treatment characteristics,molecular profiles,and the effects of different treatments in the real world on overall survival(OS) and progression free survival(PFS) were analyzed.Results According to the inclusion and exclusion criteria,92 patients with KRAS mutation and 164 patients with KRAS wild-type advanced lung adenocarcinoma were collected.The median age of the KRAS group was 64 years old,95.7% were male,91.3% were smokers.In the second-generation sequencing results,51.5% were KRAS G12C subtype group,and48.5% were non-G12C subtype group.In the survival analysis,the median PFS of KRAS mutant group was compared with that of wild group(5.2 months vs.6.8 months,P=0.22),and the difference was statistically significant.Among subtypes,the difference of the median overall survival(mO S) of G12C and nonG 12C groups was statistically significant(11.5 months vs.6.35 months,P=0.12).Of the five treatment groups,the KRAS mutation group and G12C group treated with antiangiogenic agents had the longest OS(single chemotherapy vs.antivascular drugs vs.immunotherapy vs.three-drug combination group vs.proprietary Chinese medicine:9.0 months vs.20.0 months vs.10.0 months vs.15.0 months vs.2.0 months,P<0.001),the difference was statistically significant.The three-drug combination group had the highest treatment response rate and the longest survival(mO S not yet achieved) in the nonG 12C group.Conclusion The prognosis of patients with KRAS mutation is worse than that of wild-type patients,and the survival prognosis of G12C

关 键 词：KRAS突变 肺腺癌 一线治疗 免疫检查点抑制剂 抗血管生成治疗 

分 类 号：R734.2[医药卫生—肿瘤]