血清甲状腺转录因子1水平对表皮生长因子受体酪氨酸激酶抑制剂治疗肺腺癌效果的评估价值

Value of serum thyroid transcription factor-1 level in evaluating the efficacy of epdermal growth factor receptor-tyrosine kinase inhibitors treatment lung adenocarcinoma

目的研究血清甲状腺转录因子1(TTF-1)水平对表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)疗效评估的价值。方法选取2015年3月至2016年2月河北北方学院附属第一医院收治的行EGFR-TKIs一线治疗肺腺癌晚期患者95例为肺腺癌组,另选取同期健康体检者95例为正常对照组,通过酶联免疫吸附试验法检测治疗前血清TTF-1水平。Kaplan-Meier法分析血清TTF-1水平对患者3年总生存率的影响;COX风险回归模型分析影响患者不良预后的危险因素。结果肺腺癌患者治疗前血清TTF-1水平高于正常对照组[(16±5)μg/L比(11±4)μg/L],差异有统计学意义(t=7.944,P <0.001)。完全缓解者、部分缓解者治疗前血清TTF-1水平低于疾病稳定者和疾病进展者,差异均有统计学意义(均P <0.05)。治疗前血清TTF-1水平与脑转移、胸膜转移、肿瘤TNM分期、美国东部肿瘤协作组评分有关,差异均有统计学意义(均P <0.05)。血清TTF-1高表达者3年总生存率为5.3%(2/38),显著低于TTF-1低表达患者[50.9%(29/57)](χ2=19.554,P <0.001)。COX多因素分析发现,肿瘤TNM分期高、脑转移、血清TTF-1水平高是影响肺腺癌患者EGFR-TKIs治疗后不良预后的独立危险因素(均P <0.05)。结论治疗前血清TTF-1水平高与肺腺癌患者EGFR-TKIs治疗后近期疗效、远期生存率及不良结局有关,可能对肺腺癌EGFR-TKIs疗效有一定评估价值。

Objective To study the value of serum thyroid transcription factor-1( TTF-1) level in evaluating the efficacy of epdermal growth factor receptor-tyrosine kinase inhibitors( EGFR-TKIs) treating lung adenocarcinoma.Methods Ninety-five patients with advanced lung adenocarcinoma who received EGFR-TKIs as first-line treatment from March 2015 to February 2016 in the First Affiliated Hospital of Hebei North University were selected as the lung adenocarcinoma group. Ninety-five healthy people in the same period were selected as the normal control group. The level of TTF-1 in serum was detected by enzyme-linked immunosorbent assay. The effect of serum TTF-1 level on 3-year overall survival rate of patients with lung adenocarcinoma was analyzed by Kaplan-Meier method;the risk factors of adverse prognosis after EGFR-TKIs treatment were analyzed by COX risk regression model. Results Before treatment,the level of TTF-1 in serum of lung adenocarcinoma group was significantly higher than that in the normal control group [( 16 ± 5) μg/L vs( 11 ± 4) μg/L];the difference is statistically significant( t = 7. 944,P < 0. 001). The serum TTF-1 levels before treatment in complete response and partial response were lower than those in stable disease and progressive disease( all P < 0. 05). Before treatment,the serum TTF-1 level was related to eastern cooperative oncology group score,tumour TNM stage,brain metastasis and pleural metastasis( all P < 0. 05). Kaplan-Meier analysis showed that the 3-year overall survival rate of patients with high TTF-1 expression was 5. 3%( 2/38),which was significantly lower than 50. 9%( 29/57) of patients with low TTF-1 expression( χ2= 19. 554,P < 0. 001). COX multivariate analysis showed that high tumour TNM stage,brain metastasis and high serum TTF-1 level were independent risk factors for poor prognosis of patients with lung adenocarcinoma after EGFR-TKIs treatment( all P < 0. 05). Conclusion The high level of serum TTF-1 is related to the short-term efficacy,long-term survival rate and adverse outcomes of EGFR-TKIs in patients with lung adenocarcinoma,which can evaluate the efficacy of EGFR-TKIs in lung adenocarcinoma.