EGFR基因突变状态与晚期肺腺癌一线化疗疗效的相关性

Correlation between EGFR mutation status and the efficacy of first-line chemotherapy in advanced lung adenocarcinoma

目的探讨EGFR基因突变与晚期肺腺癌患者一线化疗疗效的相关性。方法回顾性分析103例接受培美曲塞联合铂类(顺铂或者卡铂)方案一线化疗的Ⅲb期/Ⅳ期肺腺癌患者,根据EGFR基因突变状态分析临床特征与化疗疗效的关系。结果在全部103例患者中,EGFR突变型36例(35.0%),野生型67例(65.0%)。患者一线均接受培美曲塞联合铂类方案化疗,客观缓解率(Objective response rate,ORR)为27.2%,疾病控制率(Disease control rate,DCR)为71.8%。EGFR突变患者的DCR显著高于野生型患者(86.1%vs.64.2%,P=0.018)。所有患者的中位无进展生存时间(Progression free survival,PFS)为6个月,其中EGFR突变型患者PFS(8个月)优于野生型患者(5个月),差异有统计学意义(P=0.004)。Cox多因素分析显示,EGFR突变是影响PFS的独立预测因素(HR=0.684,95%CI:0.541~0.865,P=0.002)。结论 EGFR突变型患者一线接受培美曲塞联合铂类方案化疗,DCR和PFS均显著优于野生型患者。EGFR突变对晚期肺腺癌患者一线化疗PFS有预测意义。

Objective To investigate the relationship between EGFR mutations and the response to first-line chemotherapy in patients with advanced lung adenocarcinoma.Methods A total of 103 patients with stage Ⅲb/Ⅳ lung adenocarcinoma who received pemetrexed plus platinum（cisplatin or carboplatin） regimen as first-line chemotherapy were investigated retrospectively,and their clinical data was assessed according to EGFR mutation.Results In 103 patients,36 cases（35.0%） harbored EGFR-activating mutations and 67 patients（65.0%） were EGFR wild-type.All patients received first-line pemetrexed plus platinum（cisplatin or carboplatin） regimen therapies.The objective response rate（ORR） was 27.2% and disease control rate（DCR） was 71.8%.Patients with EGFR-activating mutations had a higher DCR than EGFR wild-type patients（86.1% vs.64.2%,P = 0.018）.The median progression free survival（PFS） of all enrolled patients was 6 months,and PFS in patients with EGFR-activating mutations was significantly higher than that in EGFR wild-type patients（8 months vs.5 months,P = 0.004）.Cox multivariate analysis indicated the EGFR-activating mutation was an independent factor affecting PFS（HR = 0.684,95% CI：0.541 ～ 0.865,P =0.002）.Conclusion Advanced lung adenocarcinoma patients with EGFR mutation respond better to first-line chemotherapy than EGFR wild-type patients.EGFR mutation is a predictor for PFS of first-line chemotherapy in advanced lung adenocarcinoma patients.