基因检测指导Ⅱ、ⅢA期非小细胞肺癌术后辅助化疗的临床研究

Clinical study of postoperative individualized chemotherapy based on genetic testing results for non-small cell lung cancer

目的探讨以基因检测为指导的非小细胞肺癌(NSCLC)术后个体化治疗的效果。方法将接受全胸腔镜肺癌根治术的Ⅱ、ⅢA期NSCLC患者56例随机分为个体化治疗组26例和非个体化治疗组30例,取个体化治疗组患者新鲜肿瘤组织进行基因检测,检测靶标包括切除修复交叉互补复合体1(ERCC1)、核苷酸还原酶亚单位1(RRM1)、β微管蛋白Ⅲ、胸苷酸合成酶(TS)、表皮生长因子受体(EGFR)、乳腺癌敏感蛋白1(BRCA1)等。个体化治疗组根据检测结果制定化疗方案,非个体化治疗组采用"吉西他滨+顺铂"方案,比较2组1年、2年无疾病生存率(DFS)、疾病无进展生存期(PFS)和总生存期(OS)。结果个体化治疗组2年DFS(57.69%)、PFS(月:22.1±5.0)和OS(月:24.1±3.2)均高于非个体化治疗组(分别是30.00%、18.9±6.2、21.9±4.3,均P<0.05);2组1年DFS(88.46%vs 83.33%)差异无统计学意义。结论基于基因检测的个体化治疗可以提高NSCLC术后的2年DFS、PFS和OS,提高化疗的有效率。

Objective To explore the efficiency of postoperative individualized chemotherapy based on genetic testing results for non-small cell lung cancer （NSCLC）. Methods Fifty-six NSCLC patients at stageⅡorⅢA who accepted video-assisted thoracic operation were divided into two groups：the individualized chemotherapy group （n=26） and non individualized chemotherapy group （n=30）. The fresh lung tumor tissue of individualized chemotherapy group was tested target gene,including excision repair cross complementing 1 （ERCC1）,ribonucleotide reductase subunit M1 （RRM1）,β-tubulinⅢ,thymidylate synthase（TS）,epidermal growth factor receptor （EGFR） and breast cancer gene 1 （BRCA1）. The theraputic plan was based on genetic testing results in individualized chemotherapy group, and the non individualized chemotherapy group receiving gemcitabine plus cisplatin. The 1-year disease free survival （DFS）, 2-year disease free survival （DFS）, the progression-free survival （PFS） and the overall survival （OS） were compared between two groups. Results The 2-year DFS （57.69%）, PFS （22.1 ± 5.0 months） and OS （24.1 ± 3.2 months） were significantly higher in the individualized chemotherapy group than those of non individualized chemotherapy group （respectively 30.00%, 18.9 ± 6.2 months, 21.9 ± 4.3 months, P〈0.05）. There was no significant difference in 1-year DFS between two groups （88.46%vs 83.33%, P〈0.05）. Conclusion The individualized chemotherapy based on genetic testing results can enhance the 2-year DFS, PFS, OS and the efficiency of postoperative adjuvant chemotherapy for NSCLC.