摘要
目的分析中国不同表皮生长因子受体（EGFR）敏感突变类型非小细胞肺癌（NSCLC）患者一线接受EGFR-酪氨酸激酶抑制剂（EGFR—TKIs）治疗的疗效和预后。方法回顾性分析经组织学确诊的ⅢB期或Ⅳ期且接受过EGFR突变检测的NSCLC患者的临床资料，分析敏感突变患者接受EGFR．TKIs一线治疗的疗效和预后差异。结果共纳入165例EGFR敏感突变且接受EGFR—TKIs一线治疗的NSCLC患者，其中71例为外显子19缺失（19del），80例为L858R突变，14例为少见敏感突变患者。19del组和L858R突变组患者的客观缓解率（ORR）分别为57．8％和45．0％，差异无统计学意义（P=0．113）；疾病控制率（DCR）分别为93．0％和93．8％，差异亦无统计学意义（P=0．158）。少见敏感突变组患者的ORR和DCR分别为35．7％和78．6％，均明显低于19del组和L858R突变组（P=0．035，P=0．020）。19del组、L858R突变组和少见敏感突变组患者的中位无进展生存时间（PFS）分别为14．0、7．8和5．1个月，3组患者的中位PFS差异有统计学意义（P=0．001）；19del组和L858R突变组患者的中位PFS差异亦有统计学意义（P=O0009）。19del组、L858R突变组和少见敏感突变组患者的中位生存时间（0s）分别为22．8、15．2和10．0个月，3组患者的中位0s差异有统计学意义（P=0．048）；但19del组和L858R突变组患者的中位0s差异无统计学意义（P=0．152）。多因素分析结果显示，体力状况评分（P=0．030）、吸烟状态（P=0．013）和EGFR突变类型（P=0．034）是0s的独立影响因素。结论对于中国NSCLC患者，不同EGFR敏感突变患者一线接受EGFR—TKIs治疗的疗效和预后并不相同。19del组患者的中位PFS明显优于其他敏感突变类型，但中位OS与L858R突变组相似；常见敏感突变类型患者的中位PFS和0s均明显优于少见敏感突变患者。
Objective To analyze whether there are differences in the efficacy and clinical outcomes to first-line tyrosine kinase inhibitors （TKI） therapy in Chinese patients with metastatic non-small- cell lung cancer （NSCLC） harboring different subtypes of epidermal growth factor receptor （EGFR） mutations. Methods A retrospective analysis was made on the clinical data of stage IU B or 1V NSCLC patients who were diagnosed by histology and received EGFR mutation test, in order to confirm if there is any difference between the therapeutic effects of TKIs as first-line therapy and the prognosis. Results A total of 165 patients harboring EGFR exon 19 deletion （ 19del, n = 71 ）, exon 21 L858R mutation （ L858R, n = 80） or uncommon sensitive mutation （n = 14 ） were treated with EGFR-TKIs for first-line treatment. The comparison among different groups of common types of sensitive mutations revealed that the objective response rate （ORR） of group 19del and group L858R were 57.8% and 45.0%, respectively （P= 0.113）. The disease control rate （DCR） was 93.0% and 93.8%, respectively （P= 0.158）. However, the ORR and DCR of uncommon sensitive mutation were 35.7% and 78.6%, which were significantly lower than that of the group 19del （P= 0.035） and group L858R （P = 0.020）. The median progression-free survival （PFS） of group 19del, group L858R and uncommon sensitive mutation were 14.0 months, 7.8 months and 5.1 months, respectively （P= 0.001 ）.The median PFS of the group 19del was significantly longer than that of the group L858R （P = 0.009）. The median overall survival （OS） of these three groups had significant difference （22.8, 15.2 and 10.0 months） （P=0.048）. But those of group 19del and group L858R were similar （P=0.152）. The multivariate analysis indicated that ECOG-PS （P= 0.030）, cigarette smoking （ P= 0.013） and EGFR mutation types （P= 0.034） are independent prognostic factors of OS. Conclusions For Chinese NSCLC patients with different types of sensitive mutation, there are differences between their efficacy and prognosis of EGFR-TKIs as first-line treatment. The PFS of group 19del is obviously longer than that of other types of sensitive mutations, but have no significant differences in OS. The PFS and OS of patients with common types of sensitive mutation are better than those with uncommon sensitive mutation.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2016年第3期211-217,共7页
Chinese Journal of Oncology
关键词
癌
非小细胞肺
表皮生长因子受体
酪氨酸激酶抑制剂
预后
Carcinoma, non-small-cell lung
Epidermal growth factor receptor
Tyrosine kinase inhibitors
Prognosis
作者简介
通信作者：程颖，Email：jl．cheng@163．com
