EGFR-TKI靶向治疗对是否伴恶性胸腔积液非小细胞肺癌患者的疗效比较

Effect of EGFR-TKI targeted therapy on NSCLC patients with or without malignant pleural effusion

目的探讨表皮生长因子受体-酪氨酸激酶抑制药(EGFR-TKI)靶向治疗对是否伴恶性胸腔积液非小细胞肺癌(NSCLC)患者的疗效差异。方法回顾性分析120例晚期NSCLC患者的病历资料,根据患者是否伴有恶性胸腔积液分为A组66例(伴有胸腔积液)和B组54例(不伴有胸腔积液),两组均采用基础治疗+EGFR-TKI治疗,比较两组患者的疗效差异及治疗前和治疗3个月后的KPS评分、血清癌胚抗原(CEA)、鳞状上皮细胞癌抗原(SCC)、神经元特异性烯醇化酶(NSE)、血管内皮细胞生长因子(VEGF)水平的变化。结果 A组患者的缓解率为50.00%、总有效率为81.82%,均低于B组的70.37%、94.44%,两组比较,差异均有统计学意义(P﹤0.05)。治疗前,A组和B组患者的血清CEA、SCC、NSE、VEGF水平比较,差异均无统计学意义(P﹥0.05);治疗后,两组患者的血清CEA、SCC、NSE、VEGF水平均较本组治疗前降低(P﹤0.05),且A组患者的血清CEA、SCC、NSE、VEGF水平均明显高于B组,差异均有统计学意义(P﹤0.01)。治疗前、治疗后两组患者的KPS评分比较,差异均有统计学意义(P﹤0.05),但A组患者治疗前后的KPS评分差值明显低于B组患者,差异有统计学意义(P﹤0.01)。结论EGFR-TKI靶向治疗对是否伴恶性胸腔积液NSCLC患者均具有一定的临床效果,但是对不伴恶性胸腔积液的患者效果更好,患者的KPS评分提高的更多。

Objective To investigate the effect of epidermal growth factor receptor-tyrosine kinase inhibitor（EGFR-TKI） targeted therapy on patients with non-small cell lung cancer（NSCLC） and with or without malignant pleural effusion. Method The medical records of 120 patients with advanced NSCLC were retrospectively analyzed. According to the presence of malignant pleural effusion, 66 patients（with pleural effusion） were included as group A, and 54 patients（without pleural effusion） were stratified as group B, and both groups were treated with basic therapy ＋ EGFR-TKI, and the difference in efficacy between the two groups was compared, besides, the KPS scores, serum CEA, SCC, NSE, VEGF levels before treatment and 3 months after treatment were also assessed. Result The remission rate was 50.00% and the total response rate was 81.82% in group A, which was lower than 70.37% and 94.44% in group B, respectively, the difference was statistically significant（P0.05）. Before treatment, the serum levels of CEA, SCC, NSE and VEGF in group A and group B were not significantly different（P0.05）; while after treatment, the serum levels of CEA, SCC, NSE and VEGF in the two groups were significantly decreased as compared with that before treatment（P0.05）, besides, significantly higher serum levels of CEA, SCC, NSE and VEGF were observed in group A than in group B（P0.01）. The KPS scores of the two groups before and after treatment were significantly different（P0.05）, however, the difference of KPS scores before and after treatment in group A was significantly lower than that in group B, showing statistically significant difference（P0.01）. Conclusion EGFR-TKI targeted therapy is fairly effective in NSCLC patients with or without malignant pleural effusion, but it is clinically better for those without pleural effusion, with greater improvement for KPS score.