吉非替尼联合全脑放疗治疗EGFR阳性肺癌脑转移临床疗效观察及对血清CA199 MMP-9 HMGB1水平的影响  

Clinical Efficacy of Gefitinib combined with Whole-brain Radiotherapy on Epidermal Growth Factor Receptor-positive Lung Cancer with Brain Metastases and Its Impacts on Serum CA199 MMP-9 and HMGB1 Levels

作　　者：杨泽兴 何占彪[1] YANG Zexing;HE Zhanbiao(The Affiliated Hospital of Inner Mongolia Medical University,Inner Mongolia Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院放疗科,内蒙古呼和浩特010050

出　　处：《河北医学》2025年第1期170-174,共5页Hebei Medicine

基　　金：内蒙古医科大学“科技百万工程”项目,(编号:YKD2020KJBW(LH)035);内蒙古自治区医师协会临床医学研究和临床新技术推广项目,(编号:YSXH2024KYD22)。

摘　　要：目的:探讨吉非替尼联合全脑放疗治疗表皮生长因子受体(EGFR)阳性肺癌脑转移的价值。方法:选取2019年1月至2020年12月放射治疗科收治的78例EGFR阳性肺癌脑转移患者为对象,以随机数字表法进行分组,将患者分为对照组、观察组开展单盲研究,每组39例。对照组行单独全脑放疗治疗,观察组在全脑放疗基础上联合吉非替尼治疗。评估持续治疗3个月后的效果,同时观察治疗前与治疗3个月后患者血清糖类抗原19-9(CA19-9)、基质金属蛋白酶9(MMP-9)、高迁移率族蛋白B1(HMGB1)水平变化情况,并对患者进行持续随访,观察中位肿瘤无进展时间和2年的生存率,统计患者毒副反应反生率。结果:3个月后疗效评估,观察组客观缓解率高于对照组(P<0.05),疾病控制率相当(P>0.05);观察组疾病控制率(69.23%)高于对照组(45.15%),(P<0.05)。同时,治疗后观察组患者血清CA199、MMP-9、HMGB1水平分别低于对照组,而差值则高于对照组(P<0.05)。观察组中位肿瘤无进展时间(5.28±1.08)个月较对照组(4.45±1.02)个月长,2年生存率(61.54)较对照组(38.46%)高(P<0.05)。结论:在全脑放疗基础上联合吉非替尼靶向治疗EGFR阳性肺癌脑转移,可更好地控制癌细胞转移、促进患者肿瘤标志物水平改善,继而提高疾病控制率和短期生存率,在安全性方面与单独放疗相当。Objective:To investigate the value of gefitinib combined with whole-brain radiotherapy in the treatment of epidermal growth factor receptor(EGFR)-positive lung cancer with brain metastasis.Methods:A total of 78 patients with EGFR-positive lung cancer with brain metastases admitted to the Department of Radiation Therapy from January 2019 to December 2020 were recruited,and they were randomized 1:1 to whole-brain radiotherapy(control group)or gefitinib+whole-brain radiotherapy(observation group).After 3-month treatment,the curative effect was evaluated,and the changes in serum levels of carbohydrate antigen 19-9(CA19-9),matrix metalloproteinase-9(MMP-9),and high mobility group box-B1(HMGB1)were assessed before and after 3 months of treatment,and the patients were followed up continuously to observe the median progression-free survival(PFS)and the 2-year survival rate,and the incidence of the adverse effects was counted.Results:After 3-month treatment,the objective remission rate in the observation group was significantly higher than that of the control group(P<0.05),but the disease control rate was comparable between groups(P>0.05),and the disease control rate in the observation group was significantly higher than that of the control group(69.23%vs 45.15%,P<0.05).After treatment,the serum CA19-9,MMP-9 and HMGB1 levels in the observation group were significantly lower than those of the control group(P<0.05).The median PFS(5.28±1.08 months vs 4.45±1.02 months)and 2-year survival rate(61.54%vs 38.46%)in the observation group were significantly longer than those of the control group(P<0.05).Conclusion:Gefitinib combining with whole-brain radiotherapy for brain metastasis of EGFR-positive lung cancer can better control cancer cell metastasis,improve tumor marker levels,thereby increasing the disease control rate and short-term survival rate,and it is comparable to radiotherapy alone in terms of safety.

关 键 词：肺癌 脑转移 全脑放疗 吉非替尼 肿瘤标志物 生存率 

分 类 号：R734.2[医药卫生—肿瘤]