安罗替尼治疗晚期非小细胞肺癌患者的效果及对生存预后的影响  

Efficacy of anlotinib in treatment of patients with advanced non-small cell lung cancer and its impact on prognosis

作　　者：闫绍辉 王栋 徐凯 付晏 Yan Shao-hui;Wang Dong;Xu Kai;Fu Yan(Department of Thoracic Oncology,the Fourth Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第四医院胸部肿瘤科,秦皇岛066000

出　　处：《中国药物应用与监测》2024年第5期582-586,共5页Chinese Journal of Drug Application and Monitoring

基　　金：秦皇岛市重点研发计划科技支撑项目(202005A025)。

摘　　要：目的 探究安罗替尼治疗晚期非小细胞肺癌(NSCLC)患者的效果及对预后的影响。方法 选取2020年7月至2022年12月秦皇岛市第四医院收治的表皮生长因子受体(EGFR)、间变性淋巴瘤激酶(ALK)或c-ros肉瘤致癌因子-受体酪氨酸激酶(ROS1)阳性、酪氨酸激酶抑制剂(TKI)治疗后疾病进展、活动状态(PS)评分≤2分、二次基因检测结果为T790M阴性、处于ⅢB~Ⅳ期的非鳞癌NSCLC患者,根据治疗方法的不同分为化疗组(给予培美曲塞+卡铂注射液化疗方案治疗)和安罗替尼组(给予口服安罗替尼+培美曲塞+卡铂注射液化疗方案治疗),经倾向性匹配评分法(卡钳值0.02)排除性别、年龄等混杂因素,两组各获得46例患者。比较化疗4周期后的实体瘤治疗效果[疾病控制率(DCR)、客观缓解率(ORR)]、随访1年生存情况[无进展生存期(PFS)、总生存期(OS)]、药物不良反应,比较两组化疗前、化疗4周期后血清肿瘤标志物[细胞角蛋白19片段抗原(CY-FRA21-1)、神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)]及血清细胞间黏附分子-1(ICAM-1)、热休克蛋白90α(Hsp90α)水平变化情况。结果 治疗4周期后,安罗替尼组DCR(73.91%vs 52.17%)高于化疗组(χ^(2)=4.665,P<0.05),ORR(43.48%vs 34.78%)与化疗组差异无统计学意义(χ^(2)=0.730,P>0.05);随访1年,化疗组PFS为(6.81±1.66)个月,死亡29例,OS为(7.33±1.71)个月;安罗替尼组PFS为(8.17±2.32)个月,死亡19例,OS为(10.56±1.84)个月,安罗替尼组PFS(log rankχ^(2)=8.331,P<0.05)、OS(χ^(2)=8.394,P<0.05)高于化疗组;在治疗期间,安罗替尼组患者蛋白尿和高血压发生率高于化疗组(P<0.05);治疗4个周期后,两组血清肿瘤标志物CY-FRA21-1、NSE、CEA水平及血清ICAM-1、Hsp90α水平均降低(P<0.05),且安罗替尼组[(3.24±0.72) ng·mL^(-1)、(16.65±3.07) ng·mL^(-1)、(13.27±2.49) ng·mL^(-1)、(0.56±0.11) ng·mL^(-1)、(82.67±9.67) ng·mL^(-1)]低于化疗组[(3.88±0.84) ng·mL^(-1)、(18.24±3.12) ng�Objective To explore the efficacy of anlotinib in treatment of patients with advanced non-small cell lung cancer(NSCLC)and its impact on prognosis.Methods NSCLC patients with positive epidermal growth factor receptor(EGFR)or anaplasticlymphoma kinase(ALK),first-line chemotherapy failure,physical status(PS)score G 2 points,T790m-negative gene test result and stageⅢB-Ⅳtreated in the Fourth Hospital of Qinhuangdao from July 2020 to December 2022 were selected as the subjects.According to the treatment methods,the patients were divided into the chemotherapy group(pemetrexed+carboplatin injection second-line chemotherapy regimen)and the anlotinib group(oral anlotinib+pemetrexed+carboplatin injection secondline chemotherapy regimen).The propensity score matching method(caliper=0.02)was used to exclude confounding factors such as gender and age,and 46 patients were obtained in each group.The solid tumor treatment effect(disease control rate(DCR),objective response rate(ORR))after 4 cycles of chemotherapy,the survival status(progression-free survival(PFS),overall survival(OS))and adverse drug reactions after 1 year of follow-up as well as the levels of serum tumor marker(cytokeratin 19 fragment antigen(CYFRA21-1),neuron-specific enolase(NSE),carcinoembryonic antigen(CEA)),serum intercellular adhesion molecule-1(ICAM-1)and heat shock protein 90α(Hsp90α)before chemotherapy and after 4 cycles of chemotherapy were compared between the two groups.Results After 4 cycles of treatment,the DCR in the anlotinib group was significantly higher than that in the chemotherapy group(73.91%vs 52.17%)(χ^(2)=4.665,P<0.05),and the ORR was not significantly different from that in the chemotherapy group(43.48%vs 34.78%) ( χ^(2)=0.730, P>0.05). After follow-up for 1 year, the PFS, the number of dead cases and OS in the chemotherapy group were (6.81±1.66 ) months, 29 cases and (7.33±1.71) months and those in the anlotinib group were (8.17±2.32) months, 19 cases and (10.56±1.84) months. The PFS ( χ^(2)=8.331, P<0.05) and OS ( χ^(2)

关 键 词：晚期NSCLC 安罗替尼 生存时间 血清细胞间黏附分子-1 热休克蛋白90Α 

分 类 号：R734.2[医药卫生—肿瘤] R969[医药卫生—临床医学]