EGFR抑制剂联合放疗治疗晚期非小细胞肺癌的临床效果及其皮疹发生与生存时间的关系

Clinical Effect of EGFR Inhibitor Combined with Radiotherapy in the Treatment of Advanced Non-small Cell Lung Cancer and the Relationship between Skin Rash and Survival Time

目的探讨表皮生长因子受体(epidermal growth factor receptor,EGFR)抑制剂联合放疗治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床效果及其皮疹发生与生存时间的关系。方法选取2016年2月—2017年2月收治的92例晚期NSCLC,根据治疗方法的不同,分为观察组(n=50)与对照组(n=42)。对照组行单纯放疗,观察组予EGFR抑制剂联合放疗。两组均在肿瘤进一步发展或出现不耐受不良反应时停止治疗,随访时间至2019年2月。评估治疗后3个月的临床效果,检测治疗前与治疗后3个月的血清相关指标[转化生长因子-α(transforming growth factor-α,TGF-α)、癌胚抗原(carcinoembryonic antigen,CEA)、细胞角蛋白19片段抗原21-1(cytokeratin 19 fragment antigen 21-1,CYFRA21-1)]水平,观察治疗期间皮疹发生情况及观察组皮疹发生与生存时间的关系,记录治疗期间不良反应发生情况。结果两组治疗后3个月客观有效率、治疗期间Ⅰ级皮疹发生率及皮疹总发生率比较差异有统计学意义(P<0.05或P<0.01)。与对照组治疗后3个月比较,观察组治疗后3个月血清TGF-α、CEA、CYFRA21-1水平降低,差异有统计学意义(P<0.01);与本组治疗前比较,两组治疗后3个月血清TGF-α、CEA、CYFRA21-1水平降低,差异有统计学意义(P<0.01)。根据治疗期间有无皮疹发生,将观察组分为皮疹亚组与无皮疹亚组。与无皮疹亚组比较,皮疹亚组生存时间延长,差异有统计学意义(P<0.01)。治疗期间,两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论EGFR抑制剂联合放疗治疗晚期NSCLC的临床效果较好,皮疹发生率高,且皮疹发生率高的患者生存时间延长。

Objective To investigate the clinical effect of epidermal growth factor receptor(EGFR)inhibitor combined with radiotherapy in the treatment of advanced non-small cell lung cancer(NSCLC)and the relationship between skin rash and survival time.Methods Ninety-two patients with advanced NSCLC admitted to our hospital from February 2016 to February 2017 were selected as the research subjects.They were divided into observation group(n=50)and control group(n=42)according to different treatment methods.The control group received radiotherapy alone,while the observation group was given EGFR inhibitors combined with radiotherapy.In both groups,the treatment was withdrawn when the tumors further developed or when intolerable toxicity and adverse reactions occurred,and they were followed up until February 2019.The clinical efficacy at 3 months after treatment was evaluated,and the levels of serum-related indicators[transforming growth factor-α(TGF-α),carcinoembryonic antigen(CEA),cytokeratin 19 fragment antigen 21-1(CYFRA21-1)]before and at 3 months after treatment were detected.The occurrence of skin rash and the relationship between skin rash and survival time in the observation group were observed,and the occurrence of adverse reactions was recorded.Results There were significant differences in the objective response rate(ORR),incidence of grade I rash and total incidence of rash during treatment between the two groups(P<0.05 or P<0.01).Compared with the control group,serum TGF-α,CEA,and CYFRA21-1 levels in the observation group were decreased at 3 months after treatment(P<0.01).Compared with those in the same group before treatment,serum TGF-α,CEA,and CYFRA21-1 levels were decreased at 3 months after treatment in both groups(P<0.01).According to the presence or absence of rash during treatment,the observation group was divided into rash subgroup and non-rash subgroup.Compared with non-rash subgroup,the survival time of the rash subgroup was prolonged(P<0.01).There was no significant difference in the total incidence of adverse reactions during treatment between the two groups(P>0.05).Conclusion EGFR inhibitor combined with radiotherapy is effective in the treatment of advanced NSCLC with high incidence of rash,and the survival time of patients with high incidence of skin rash is long.