伊马替尼治疗晚期脊索瘤患者的临床研究

A clinical study of imatinib in the treatment of advanced chordoma patients

目的研究晚期脊索瘤患者口服伊马替尼治疗的临床疗效分析。方法本研究收集2007年6月至2012年6月,在解放军总医院第一附属医院住院治疗的晚期脊索瘤患者63例,其中失访病例24例,我们长期追踪到的39例为可评价患者。患者在接受伊马替尼治疗前通过病理组化检测PDGFRβ蛋白表达情况,分为低表达组和高表达组。所有患者均口服伊马替尼的剂量为每天400 mg,每3个月进行1次CT或MRI检查肿瘤生长情况,按照RECIST标准评价临床治疗效果,同时比较两组患者对伊马替尼治疗疗效的差别,并以SPSS13.0作统计分析,P<0.05具有统计学意义;采用Kaplan-Meier法绘制患者生存曲线。结果免疫组化提示高表达PDGFRβ患者为25例,占64.1%,14例低表达患者,占35.9%;在39例可评价患者中,完全缓解(CR)病例为O例(O%),部分缓解(PR)病例为3例(8%),病情稳定(SD)患者为27例(69%),疾病进展(PD)病例为9例(23%);临床获益率为76.9%(CR%+PR%+SD%);中位无疾病进展期为9个月,中位生存时间为31.2个月。PDGFRp高表达组临床获益人数为22例(临床获益率88%),低表达组临床获益人数8例(临床获益率57.1%);两组患者相比差异有统计学意义,P值为0.0282。结论本研究提示伊马替尼在治疗晚期脊索瘤方面具有抗肿瘤活性,临床获益率较好,同时在PDGFRβ高表达的患者获得了更好的疗效。

Objective To study the clinical effects of advanced chordoma patients who were treated with oral imatinib. Methods From June 2007 to June 2012, 63 advanced chordoma patients who were admitted in our hospital were selected, including 24 cases with lost follow-up. The other 39 evaluable patients were followed up continuously. The platelet-derived growth factor receptor-β（ PDGFR-β） protein expressions were detected pathologically before patients receiving imatinib treatment, and then they were divided into low and high expression groups. The dosage of oral imatinib for all the patients was 400 mg/d. The tumor growth was examined through CT or MRI every 3 months. The Response Evaluation Criteria in Solid Tumors （ RECIST ） was used to evaluate the clinical effects, and at the same time the differences in clinical effects of imatinib treatment between the 2 groups was compared. The Statistical Package for the Social Sciences Version 13.0 （ SPSS13.0 ） was used in statistical analysis, and P＆lt;0.05 meant that there were statistically signiifcant differences. The survival curve was drawn using the Kaplan-Meier method. Results Immunohistochemistry results were listed as follows. 25 patients had high expression of PDGFRβ, accounting for 64.1%. 14 patients had low expression of PDGFRβ, accounting for 35.9%. Among the 39 evaluable patients, no patients have complete response （ CR ）, accounting for 0%, 3 patients with partial response （ PR ）, accounting for 8%, 27 patients with stable diseases （ SD ）, accounting for 69% and 9 patients with progressive diseases （ PD ）, accounting for 23%. The clinical beneift rate was 76.9%（ CR%＋PR%＋SD%）. The median progression-free survival time was 9 months, and the median survival time was 31.2 months. The number of clinical beneifts was 22 in PDGFRβhigh expression group, and the clinical beneift rate was 88%. The number of clinical beneifts was 8 in PDGFRβlow expression group, and the clinical beneift rate was 57.1%. There were statistically signiifcant differences between the 2 groups, and the p value was 0.0282. Conclusions Our study further conifrms the anti-tumor activity of imatinib in advanced chordoma patients and good clinical beneifts. Meanwhile, better clinical effects can be achieved in PDGFRβhigh expression group.