表皮生长因子受体酪氨酸激酶抑制剂治疗肺腺鳞癌患者的疗效及影响因素

The efficacy and influence factors analysis of EGFR TKIs on patients with lung adenosquamous carcinoma

目的探讨表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）单药治疗肺腺鳞癌患者的疗效及其影响因素。方法选取2007年8月至2017年7月间就诊于中国医学科学院肿瘤医院、经病理确诊为肺腺鳞癌、接受过EGFR TKIs治疗的40例患者，回顾性分析患者口服EGFR TKIs的疗效。40例肺腺鳞癌患者均接受过EGFR突变检测，11例患者无突变，19Del突变13例，21L858R突变13例，20外显子和19/21外显子双突变3例，不吸烟和腺癌成分〉50%的患者中EGFR突变率较高。结果26例（65.0%）肺腺鳞癌患者接受EGFR TKIs靶向治疗后进展，中位无进展生存时间（PFS）为5.5个月（95% CI为0.52～10.49个月）；20例（50.0%）患者达到总生存时间（OS）终点事件，中位OS为15个月（95% CI为11.03～18.97个月）。多因素分析显示，性别、年龄、吸烟、病理组织成分、EGFR突变和EGFR TKIs治疗时有无脑转移与患者的PFS均无关（均P〉0.05）；性别、年龄、吸烟、病理组织成分和EGFR TKIs治疗时有无脑转移与患者的OS均无关（均P〉0.05），EGFR突变与患者的OS有关（P〈0.05）。结论EGFR TKIs治疗肺腺鳞癌具有一定疗效，其中EGFR突变患者疗效显著。应结合临床病理特征，通过EGFR基因突变检测和EGFR TKIs治疗以改善肺腺鳞癌患者的临床疗效。

ObjectiveTo investigate the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors （EGFR TKIs） on patients with lung adenosquamous carcinoma, and to analyze relative factors.MethodsFrom August 2007 to July 2017, 40 patients who were pathologically diagnosed as lung adenosquamous carcinoma in our hospital and received EGFR TKIs treatment were retrospectively analyzed. All patients underwent EGFR mutation detection, resulted in 11 wild type, 13 19Del, 13 21L858R mutations, and 3 uncommon EGFR mutations in 20 exon and 19/21 complex mutation. A higher frequency of EGFR mutation was found in non-smokers and patients with adenocarcinoma components over 50.0%.ResultsTwenty-six （65.0%） patients had disease progression after EGFR TKIs treatment, with a median progression-free survival （PFS） of 5.5 months （95% CI 0.52-10.49 months）. A total of 20 （50.0%） patients died with an median overall survival （OS） of 15 months （95% CI 11.03-18.97 months）. Multivariate analysis showed that gender, age, smoking, histopathological subtypes, EGFR mutations, and brain metastasis had no influence on PFS （all P〉0.05）. Gender, age, smoking, histopathological subtypes, and the presence of brain metastasis during TKI treatment had no influence on OS （P〉0.05）, while EGFR mutation is the only influencing factor of OS （P〈0.05） in the current study.ConclusionsEGFR TKIs had modest efficacy in lung adenosquamous carcinoma, especially in patients with EGFR mutation. Based on the pathological features, EGFR mutation and EGFR TKIs treatment should be introduced into the routine clinical practice to improve the survival of patients with lung adenosquamous carcinoma.