EGFR19和21外显子突变的NSCLC的临床特征及对EGFR-TKIs的效果比较

Comparison of clinical characteristics and the effect of EGFR-TKIs with non-small cell lung cancer patients harbouring EGFR mutations in Exons 19 and 21

目的探讨晚期非小细胞肺癌(NSCLC)不同的表皮生长因子受体(EGFR)敏感突变类型对表皮细胞生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)疗效的相关性。方法回顾性收集新疆医科大学附属肿瘤医院2011-2016年确诊晚期NSCLC并接受EGFR-TKI治疗的病例。采用Kaplan-Meier单因素、Cox多因素分析方法,探讨晚期NSCLC患者接受EGFR-TKIs的生存情况及影响因素。结果共收集226例接受EGFR-TKI治疗的EGFR敏感的NSCLC患者,19del突变113例,21 L858R突变113例。多因素分析结果显示,EGFR突变类型是PFS的独立影响因素。经一线EGFR-TKI治疗的NSCLC患者含19del突变组的PFS优于21 L858R突变(P=0.038),经二三线EGFR-TKI治疗,19del突变组的PFS优于21 L858R突变(P=0.012)。结论经EGFR-TKI治疗的NSCLC患者含19del突变组的PFS显著优于21 L858R突变。

Objective To explore the clinical benefit from epidermal growth factor receptor-tyrosinekinase inhibitor(EGFR-TKI)in patients with advanced non-small cell lung cancer(NSCLC)harboring different EGFR sensitive mutation sites.Methods NSCLC patients were treated with first-generation EGFR-TKIs were retrospectively collected in 2011—2016 from Department of pharmacy,the Affiliated Tumor Hospital of Xinjiang Medical University.The Kaplan-Meier method and Cox regression were performed for univariate and multivariate analyses,respectively,to explore the independent predictors influencing the survival of patients with NSCLC.Results A total of 226 patients harboring EGFR exon 19 deletion(19Del,n=113)and exon 21 L858R mutation(21 L858R,n=113)were treated with EGFR-TKI for first-line or second-and three-line treatment.The muitivariate analysis indicated that EGFR mutation types are independent prognostic factors of PFS,NSCLC patients with exon 19 deletion could achieve longer mPFS than patients with 21 L858R in the first-line EGFR-TKI therapy(P=0.038),NSCLC patients with exon 19 deletion could achieve longer mPFS than patients with 21 L858R in the second-and three-line EGFR-TKI therapy(P=0.012).Conclusion Advanced NSCLC patients harboring exon 19 deletion receiving EGFR-TKI treatment had more significant advantage of PFS than those harboring exon 21 L858R mutation.