一代表皮生长因子受体酪氨酸激酶抑制剂一线治疗晚期非小细胞肺癌患者166例无进展生存期分析

First-generation epithelial growth factor receptor tyrosine kinase inhibitor in the first-line treatment of advanced non-small cell lung cancer: 166 cases analysis of progression-free survival

目的探讨一代表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(TKI)一线治疗晚期非小细胞肺癌(NSCLC)EGFR基因敏感突变患者的无进展生存(PFS)时间获益分析。方法随访2016—2017年中南大学湘雅医院一代EGFR-TKI一线治疗的166例非小细胞肺癌患者,根据PFS将患者分为PFS≤3个月组、>3～<12个月组、≥12个月组,分析PFS的获益因素。结果一代EGFR-TKI为影响PFS的独立因素(P<0.05),其中厄洛替尼进展的风险是埃克替尼的2.16倍,吉非替尼进展的风险是埃克替尼的4.48倍。PFS≤3个月和PFS≥12个月两组的Logistic回归分析显示,埃克替尼组疗效最佳(埃克替尼对吉非替尼,P=0.009;埃克替尼对厄洛替尼,P=0.006),EGFR 19号外显子del (19del)突变组优于EGFR 21号外显子L858R点突变组(21L858R)(P=0.024),腺癌组优于非腺癌组(P=0.044),中分化组优于低分化组(P=0.022)。多因素分析显示,埃克替尼组疗效优于厄洛替尼和吉非替尼组(P分别为0.018和0.006),腺癌组优于非腺癌(P=0.015),中分化组优于低分化组(P=0.034)。结论组织学类型、分化程度、EGFR基因等基线状态的不同可致不同PFS,一代EGFR-TKI药物为影响PFS的独立因素。

Objective Explore the clinical benefit factors of progression-free survival(PFS) in sensitive epithelial growth factor receptor(EGFR) gene mutated advanced non-small cell lung cancer patients treated with first-generation of EGFR tyrosine kinase inhibitor(TKI).Methods The clinical data of 166 patients who received first-line treatment with first-generation EGFR-TKI were retrospectively collected in 2016-2017 from Xiangya Hospital, Central South University. The patients were divided into three groups: PFS≤3 m,3 m<PFS<12 m, PFS≥12 m, and clinical beneficial features about PFS were analyzed. Results The first generation of EGFR-TKI is independent factors affecting PFS, and the risk of progression of erlotinib was 2.16 times that of icotinib, and the risk of progression of gefitinib was 4.48 times that of icotinib.Logistic regression analysis of PFS≤3 m and PFS≥12 m showed that the efficacy of Icotinib was the best(Icotinib vs. Gefitinib, P=0.009;Icotinib vs. Erlotinib, P=0.006). PFS in the EGFR 19 del group was superior to that in the EGFR21 L858 R group(P=0.024). PFS in the adenocarcinoma group was superior to that in the non-adenocarcinoma group(P=0.044). PFS in moderate differentiation group was superior to that in the lower differentiation group(P=0.022). Multivariate analysis showed that the efficacy of the icotinib group was better than that of the erlotinib and gefitinib group(P=0.018;P=0.006), and the adenocarcinoma group was superior to non-adenocarcinoma(P=0.015), and the medium differentiated group was better than the poorly differentiated group(P=0.034). Conclusion NSCLC patients with EGFR sensitive mutation may have different PFS at different baseline states such as histological type, differentiation degree, EGFR gene mutation type. First-generation EGFR-TKI may be an independent factor affecting PFS.