EGFR-TKI靶向联合尿激酶精准治疗非小细胞肺癌伴MPE 1例并文献复习

Precise Targeted Therapy of EGFR-TKI Combined with Urokinase for Non-small Cell Lung Cancer with MPE:One Case Report and Literature Review

目的探讨表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)靶向联合尿激酶精准治疗非小细胞肺癌(non-small cell lung cancer,NSCLC)伴恶性胸腔积液(malignant pleural effusion,MPE)的临床疗效,为诊治晚期非小细胞肺癌提供可靠依据。方法以诊治的NSCLC伴MPE患者为例,进行回顾性分析,并复习相关文献。结果胸水超声提示多房包裹性胸腔积液,胸水脱落细胞学病理提示为肺腺癌,胸水基因检测EGFR21 L858R突变,予口服吉非替尼250 mg,1次/日,联合尿激酶胸腔内给药治疗,能有效地抑制肺癌细胞的增殖和转移,减少恶性胸腔积液渗出,防止胸膜粘连,减轻胸腔积液对患者生活质量的严重困扰。结论EGFR-TKI基因靶向一线精准治疗NSCLC并MPE效果显著,联合尿激酶可有效溶解包裹性胸腔积液,缓解反复胸腔积液所致呼吸困难及胸痛等症状,提高患者生存质量,延长患者生存期,为临床诊治提供一定依据。

Objective To investigate the clinical efficacy of precise targeted therapy of epidermal growth factor receptor,tyrosine kinase inhibitor(EGFR-TKI),combined with urokinase for non-small cell lung cancer(NSCLC)with malignant pleural effusion(MPE),so as to provide a reliable basis for the diagnosis and treatment of advanced NSCLC.Methods The patients with NSCLC combined with MPE who were diagnosed and treated were retrospectively analyzed and relevant literature was reviewed.Results Hydrothorax ultrasound showed multilocular encapsulated pleural effusion.Cytological examination of pleural effusion showed lung adenocarcinoma.EGFR21 L858R mutation was detected in pleural effusion gene.Oral administration of 250 mg of gefitinib,once a day,combined with intrapleural urokinase,could effectively inhibit the proliferation and metastasis of lung cancer cells,reduce the exudation of malignant pleural effusion,prevent pleural adhesion,and mitigate the serious influence of pleural effusion on the life quality of patients.Conclusion The precise targeted treatment of EGFR-TKI has a significant effect on NSCLC with MPE.Combined with urokinase,it can effectively dissolve encapsulated pleural effusion,relieve symptoms such as dyspnea and chest pain caused by repeated pleural effusion,thus improving patients life quality and prolonging the survival of patients,providing a certain basis for clinical diagnosis and treatment.