吸烟对表皮生长因子酪氨酸激酶抑制剂治疗晚期非小细胞肺癌疗效的影响研究

Impacts of Smoking on the Efficacy of Epidermal Growth Factor Tyrosine Kinase Inhibitors in Patients with Advanced Non- small Cell Lung Cancer

目的探讨吸烟对表皮生长因子(EGFR)-酪氨酸激酶抑制剂(TKI)治疗晚期非小细胞肺癌(NSCLC)疗效的影响。方法选取2012年1月—2014年1月天津医科大学总医院肿瘤科接受EGFR-TKI治疗的60例晚期NSCLC患者,给予厄洛替尼或吉非替尼治疗,根据不同吸烟状态分为吸烟组22例和非吸烟组38例。比较不同临床特征NSCLC患者吸烟率,两组临床疗效,Kaplan-Meier生存分析比较两组肿瘤进展时间(TTP)和总生存期(OS)。结果不同性别NSCLC患者吸烟率比较,差异有统计学意义(P<0.05);不同年龄、组织学类型、TNM分期、功能状态(PS)评分、化疗类型NSCLC患者吸烟率比较,差异无统计学意义(P>0.05)。吸烟组部分缓解1例、疾病稳定11例、疾病进展10例,非吸烟组分别为4例、27例、7例,两组临床疗效比较,差异有统计学意义(u=2.192,P=0.029)。吸烟组中位TTP为12个月,非吸烟组中位TTP为18个月,两组间差异有统计学意义(χ2=5.459,P=0.021)。吸烟组中位OS为15个月,非吸烟组中位OS为24个月,两组间差异无统计学意义(χ2=2.459,P=0.104)。结论 EGFR-TKI治疗晚期非吸烟NSCLC患者较吸烟患者更有效,且非吸烟患者无进展生存时间可能长于吸烟者。

Objective To investigate the impacts of smoking on patients with advanced non- small cell lung cancer（ NSCLC） treated with the epidermal growth factor（ EGFR）- tyrosine kinase inhibitors（ TKI）. Methods 60 advanced NSCLC patients treated with erlotinib or gefitinib from January 2012 to January 2014 were enrolled in Department of Oncology of Tianjin Medical University General Hospital. Depending on the status of smoking, patients were divided into two groups,including smoking group（ n = 22） and non- smoking group（ n = 38）. The smoking rates were compared among NSCLC patients with various clinical features. The aim of the study is comparing the clinical efficacy between the two groups. Time to tumor progression（ TTP） and overall survival（ OS） between two groups were determined by the Kaplan- Meier method. Results There was statistical difference in gender between smoking group and non- smoking group（ P〈0. 05）, while there were no statistically significant differences in age,histological type,TNM stage,PS score and kind of chemotherapy between two groups（ P〉0. 05）. In smoking group,1 case was ameliorative,11 cases were stable and 10 cases were progressive,while the counterparts were 4,27 and 7 cases in non- smoking group. There was statistically significant difference in clinical efficacy between two groups（ u = 2. 192,P = 0. 029）. The median TTP in smoking group was 12 months,while it was 18 months in non- smoking group. There was significant difference between the two groups in TTP（ χ2= 5. 459,P = 0. 021）. The median OS in smoking group was 15 months,while it was 24 months in non- smoking group. There was no statistically significant difference between the two groups in OS（ χ2= 2. 459,P = 0. 104）. Conclusion EGFR- TKI therapy is more effective for non- smoking patients with advanced NSCLC and can also prolong their TTP.