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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2017, Vol. 10 ›› Issue (01) : 20 -24. doi: 10.3877/cma.j.issn.1674-6902.2017.01.005

所属专题： 总编推荐； 文献；

论著

EGFR基因21外显子L858R突变肺腺癌患者化疗和靶向治疗疗效的回顾性分析
罗萌1, 徐瑜2, 胡义德1,†()   
  1. 1. 400037　重庆，第三军医大学新桥医院肿瘤科·全军肿瘤研究所
    2. 400037　重庆，第三军医大学新桥医院全军呼吸研究所
  • 收稿日期:2016-08-25 出版日期:2017-02-25
  • 通信作者: 胡义德
  • 基金资助:
    国家自然科学基金资助项目(81372340)

Retrospective study on the differences of efficacy of chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor treatment in advanced lung adenocarcinoma patients harboring L858R mutation

Meng Luo1, Yu Xu2, Yide Hu1,†()   

  1. 1. Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
    2. Institute of Breath, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
  • Received:2016-08-25 Published:2017-02-25
  • Corresponding author: Yide Hu
  • About author:
    Corresponding author: Hu Yide, Email:
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罗萌, 徐瑜, 胡义德. EGFR基因21外显子L858R突变肺腺癌患者化疗和靶向治疗疗效的回顾性分析[J]. 中华肺部疾病杂志(电子版), 2017, 10(01): 20-24.

Meng Luo, Yu Xu, Yide Hu. Retrospective study on the differences of efficacy of chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor treatment in advanced lung adenocarcinoma patients harboring L858R mutation[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(01): 20-24.

目的

探讨EGFR基因21外显子L858R突变肺腺癌患者使用化疗和EGFR-TKI靶向治疗疗效的差异。

方法

回顾性分析，收集第三军医大学新桥医院2010年1月至2015年12月间EGFR基因检测为21外显子L858R突变的病例资料完整的ⅢB/Ⅳ期一线接受化疗或EGFR酪氨酸激酶抑制剂(EGFR-TKI)靶向治疗的肺腺癌患者作为研究对象，将患者根据一线治疗方式分为化疗组和靶向治疗组，对两组患者近期疗效(客观缓解率ORR、疾病控制率DCR)及生存期(无进展生存期PFS、总生存期OS)进行回顾性研究。

结果

①共收集符合纳入标准的EGFR基因21外显子L858R突变的肺腺癌患者68例，其中化疗组患者40例(58.8%)，靶向治疗组患者28例(41.2%)，两组患者在性别、年龄、吸烟史、PS评分和临床分期等临床资料基线水平一致(P>0.05)；②化疗和靶向治疗组ORR分别为45.0%和17.9%(P＝0.020)；DCR分别为95.0%和71.4%(P＝0.012)，PFS分别为9.901个月和6.746个月(P＝0.045)；OS分别为21.738个月和23.611个月(P＝0.378)。

结论

与靶向治疗相比，EGFR基因21外显子L858R突变肺腺癌患者化疗治疗在近期疗效及PFS上较有优势，OS未见明显获益。

关键词: EGFR基因突变, 肺腺癌, 化疗, 靶向治疗, 临床疗效, 回顾性分析
Objective

To explore the differences of efficacy of the chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor treatment in advanced lung adenocarcinoma patients harboring exon 21 mutation.

Methods

The clinical characteristic of advanced lung adenocarcinoma harboring EGFR 21 L858R mutation receiving first-line chemotherapy and EGFR-TKI treatment in Xinqiao hospital from Jan 2010 to Dec 2015 were studied. The differences between the clinical indicators of the two groups, such as objective response rates (ORR), disease control rates(DCR), progression free survival(PFS), overall survival(OS) were analyzed.

Results

①The data of 68 patients were collected including 40 chemotherapy and 28 EGFR-TKI. Baselines of sex, age, smoking status, ECOG PS between the two groups were consistent (P>0.05) . ②The ORR of the two groups were 45% and 17.9%(P=0.020), the DCR of the two groups were 95% and 71.4%(P=0.012). The PFS of the two groups were 9.901 and 6.746 months (P=0.045), the OS of the two groups were 21.738 and 23.611 months (P=0.378).

Conclusions

Compared with EGFR-TKI, the patients of advanced lung adenocarcinoma treated with chemotherapy had significant advantage of ORR, DCR and PFS, no difference on OS.

Key words: Epidermal growth factor receptor mutation, Lung adenocarcinoma, Chemotherapy, Targeted molecular therapy, Clinical efficacy, Retrospective analysis
表1 两组患者基本临床资料(例)
临床资料 化疗(n＝40) 靶向治疗(n＝28) P值
性别 ? ? ?
? 男 20 17 0.383
? 女 20 11 ?
年龄 ? ? ?
? ≤58岁 24 13 0.269
? ≥58岁 16 15 ?
吸烟史 ? ? ?
? 有 15 8 0.444
? 无 25 20 ?
ECOG PS ? ? ?
? 0分 5 3 0.228
? 1分 35 23 ?
? 2分 0 2 ?
临床分期 ? ? ?
? ⅢB期 2 3 0.396
? Ⅳ期 38 25 ?
表2 L858R突变患者化疗及靶向治疗疗效比较[n(%)]
治疗方式 治疗效果 客观缓解率 疾病控制率
PR SD PD 合计
化疗 18 20 2 40 45.00 95.00
靶向治疗 5 15 8 28 17.86 71.43
P值 ? ? ? 0.020 0.012 ?
图1 L858R突变患者化疗及靶向治疗无进展生存期曲线
图2 L858R突变患者化疗及靶向治疗总生存期曲线
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