KRAS单突变及KRAS/TP53共突变在肺腺癌中的治疗及预后分析  

The treatment and prognosis analysis of KRAS single mutation and KRAS/TP53 co-mutation in lung adenocarcinoma

作　　者：张珊珊[1] 李玉梅[1] 黄柱华[1] 毕明宏[1] ZHANG Shanshan;LI Yumei;HUANG Zhuhua;BI Minghong(The First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院,安徽蚌埠233000

出　　处：《包头医学院学报》2024年第5期33-38,54,共7页Journal of Baotou Medical College

基　　金：安徽省教育厅自然科学基金重点项目名称:1,25D通过Hedgehog信号通路调控Bmi1介导乳腺癌侵袭转移的机制研究(KJ2021A0703)。

摘　　要：目的:比较Kristen鼠肉瘤致癌基因(kirsten rat sarcoma viral oncogene,KRAS)突变型肺腺癌患者不同突变状态、分子分型的治疗及其预后。方法:收集2019年04月-2022年04月于蚌埠医学院第一附属医院确诊且接受一线治疗的晚期KRAS突变肺腺癌患者资料,统计TP53共突变情况、分子分型并分析其治疗预后的相关性。结果:随访至2022年4月,KRAS/TP53共突变患者相较于KRAS单突变的患者,中位无进展生存期(median progression-free survival,mPFS)明显缩短(HR=0.613,95%CI:0.396-0.951,P=0.029),差异有统计学意义;化疗联合抗血管生成治疗对比单纯化疗mPFS明显延长,差异有统计学意义(HR=0.593,95%CI:0.355-0.990,P=0.038);化疗联合免疫治疗组对比单纯化疗mPFS明显延长,差异有统计学意义(HR=0.426,95%CI:0.247-0.736,P=0.02);化疗联合抗血管生成治疗组相较于化疗联合免疫治疗组mPFS对比,差异无统计学意义(HR=0.648,95%CI:0.371-1.130,P=0.126)。结论:TP53为晚期KRAS突变肺腺癌患者不良预后因素;G12C和非G12C不同分子分型间的治疗及预后无明显差异;化疗联合免疫或抗血管生成治疗对比单纯化疗可延长晚期肺腺癌患者的PFS,但联合治疗组之间的PFS无明显差异。Objective:To compare the treatment and prognosis of kirsten rat sarcoma viral oncogene(KRAS)mutant lung adenocarcinoma patients with different mutation states and molecular typing.Methods:The data of patients with advanced KRAS mutant lung adenocarcinoma who were diagnosed and received first-line therapy in the First Affiliated Hospital of Bengbu Medical College from April 2019 to April 2022 were collected.The co-mutation of TP53,molecular typing and the correlation of treatment prognosis were analyzed.Results:Follow-up to April 2022,the mPFS of patients with KRAS/TP53 co-mutation was significantly shorter than that of patients with KRAS single mutation(HR=0.613,95%CI:0.396-0.951,P=0.029),and the difference was statistically significant.The mPFS of chemotherapy combined with anti-angiogenesis therapy was significantly prolonger than that of chemotherapy alone(HR=0.593,95%CI:0.355-0.990,P=0.038).The mPFS of chemotherapy combined with immunotherapy group was significantly longer than that of chemotherapy alone(HR=0.426,95%CI:0.247-0.736,P=0.02).There was no significant difference in mPFS between chemotherapy combined with anti-angiogenesis therapy group and chemotherapy combined with immunotherapy group(HR=0.648,95%CI:0.371-1.130,P=0.126).Conclusion:TP53 is a poor prognostic factor in patients with advanced KRAS mutant lung adenocarcinoma.There is no significant difference in treatment and prognosis between different molecular subtypes of G12C and non-G12C.Chemotherapy combined with immunotherapy or anti-angiogenesis therapy can prolong PFS in patients with advanced lung adenocarcinoma compared with chemotherapy alone,but there is no significant difference in PFS between the combined treatment groups.

关 键 词：肺腺癌 KRAS突变 一线治疗 

分 类 号：R734.2[医药卫生—肿瘤]