非小细胞肺癌基因检测指导下的个体化治疗疗效分析

CLINICAL OBSERVATION OF NON-SMALL CELL LUNG CANCER PATIENTS WITH CHEMOTHERAPY BASED ON GENETIC TESTING

目的:探讨核苷酸切除修复交叉互补基因1(Excision Repair Cross Complementation l,ERCC 1)和核苷酸还原酶亚单位M 1(Subunit M l of Ribonucleotide reductase,RRM 1)分子标志物指导下的化疗药物选择在晚期NSCLC病人治疗中的有效性及安全性。方法:68例III或IV期NSCLC病人采用免疫组织化学方法检测分子标志物的蛋白表达。将晚期NSCLC病人分为分子标志物指导治疗组(A组)及对照组(B组)。A组用分子检测方法检测ERCC 1、RRM 1分子标志物,并根据检测结果确定化疗方案。B组为未经分子标志物检测的经验治疗组。经过化疗后,观察两组的疗效、无进展生存期(progressive-free survival,PFS)、总生存期(overall survival,OS)及化疗过程中的不良反应。结果:基于分子标志物检测指导下选用的化疗方案比经验性化疗方案的有效率明显提高(χ2=5.707,P=0.017),PFS明显延长(P=0.04),差异有统计学意义;两组OS无显著性差异;不良反应无明显差异。结论:分子标志物指导下的化疗方案能够提高化疗有效率,显著延长疾病无进展生存时间。吉西他滨+顺铂方案在分子标志物指导药物选择的策略下应用,将取得更高的治疗缓解率。

Objective： To explore the efficacy and safety of ERCC 1 and RRM 1molecular markers that guided strategy of chemotherapy in advanced NSCLC. Methods： This study randomly selected 68 cases of NSCLC patients who are stage III or IV. It was based on whether target tissue is appropriate for immunohistochemical detection of molecular markers. The advanced NSCLC were divided into two groups： molecular marker guide therapy group（ A） and control group（ B）. The group A was determined by the expression of ERCC 1 and RRM 1 and according to the molecular marker to select the chemotherapy drugs. The group B was no molecular marker pre-selection. After the treatment with chemotherapy,the clinical outcome,progressive- free survival（ PFS）,overall survival（ OS） and toxic adverse reactions from chemotherapy were compared between the two groups. Results： The group A has shown significant improvement in efficacy（ χ^2= 5. 707,P = 0. 017） as well as statistically significant extension in PFS（ P = 0. 04） comparing to the Group B. There was no significant difference in OS and toxic adverse reactions between the two groups. Conclusion： The chemotherapy which selected based on the molecular markers could significantly improve the efficacy and extend PFS. The chemotherapy regimens of gemcitabine plus cisplatin can achieve higher clinical remission used by the guidance of molecular marker in the advanced NSCLC.