非小细胞肺癌免疫功能与TKI治疗疗效的关系

Relationship Between Immune Function and Efficacy of EGFR-TKI Treatment in Advanced Non-small Cell Lung Cancer

[目的]研究晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitors,EGFR-TKI)的疗效和毒性与宿主免疫功能的关系。[方法]95例Ⅳ期或复发NSCLC患者接受吉非替尼或厄洛替尼治疗,52例Ⅳ期或复发NSCLC患者接受含铂化疗,检测治疗前后患者免疫功能的变化,分析患者无进展生存期(progression-free-survival,PFS)、总生存时间(overall survival,OS)和副作用。[结果]经中位18个月的随访,吉非替尼或厄洛替尼治疗患者中,免疫功能正常或上调的患者中位PFS为9.3个月,稍长于免疫功能下降的患者(7.9个月),χ2=4.3,P=0.15。免疫功能正常或上调的患者中位OS为15.7个月,长于免疫功能下降组(15.7 vs 13.2个月,χ2=10.1,P=0.001)。[结论 ]TKI治疗NSCLC患者,免疫功能上调和正常的患者OS明显延长,但与PFS没有关系。年轻可能是TKI治疗预后不好的危险因素。

[Purpose] To evaluate the immune function in advanced NSCLC patients with EGFR- TKI treatment,investigating the relationship between immune function and treatment efficacy or toxicity. [ Methods ] A total of 95 cases with stage IV or recurrent NSCLC patients received tyro- sine kinase inhibitors,and 52 cases with stage IV or recurrent NSCLC patients received chemother- apy. Immune function was detected before and after treatment ,and survival and side effects were followed-up. [Resultsl After median follow-up of 18 months,gefitinib or erlotinib-treated patients, TKI therapy group with normal or better immune function,has a median PFS time of 9.3 months, which was moderately longer than those with weaker immune function with PFS time of 7.9 months,x2= 4.3 ,P=0.15. Median overall survival in patients with better immune function was 15.7 months,which was longer than those with weaker immune function group （15.7 vs 13.2 months,x2= 10.1 ,P=-0.001）. [Conclusion] In NSCLC treated by TKI therapy,patients with normal or better im- mune function have significantly prolong overall survival, but not PFS.