EGFR突变对云南省晚期肺腺癌疗效及预后影响的真实世界研究

A real-world study of eff ect of EGFR mutation on effi cacy and prognosis of advanced lung adenocarcinoma in Yunnan Province

目的研究云南省肺腺癌患者表皮生长因子受体(epidermal growth factor receptor,EGFR)突变检测情况、表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitor,EGFR-TKI)应用情况及晚期肺腺癌治疗及预后的关系。方法收集195例初治并病理检查确诊的ⅢB~Ⅳ期肺腺癌患者资料,观察患者的年龄、性别、吸烟情况、EGFR检测情况、外周血T细胞亚群、治疗模式、客观缓解率(objective response rate,ORR)和无进展生存期(progression-free survival,PFS)等情况。结果云南省晚期肺腺癌EGFR基因检测率为65.1%(127/195),女性及不吸烟患者EGFR突变更常见(P=0.003;P=0.001)。EGFR突变阳性的肺腺癌患者EGFR-TKI应用率为93.8%(61/65)。一线使用EGFR-TKI治疗患者的ORR及PFS均优于一线使用化疗的患者(72.1%vs 41.9%,P<0.01;10.7个月vs 7.3个月,P=0.038)。多因素分析显示,EGFR突变及脑转移是PFS的预后因素(P=0.009;P=0.014),总生存数据尚不成熟。对患者治疗前后的外周血T细胞亚群比较发现,化疗或靶向治疗并未损害患者免疫功能。结论EGFR-TKI靶向治疗是云南省EGFR敏感突变阳性的晚期肺腺癌患者的首选治疗方法。EGFR基因突变可作为晚期肺腺癌患者的疗效预测及预后因素。

Objective To observe the detection situation of epidermal growth factor receptor(EGFR)mutation and the application of epidermal growth factor receptor-tyrosine kinase inhibitor(EGFR-TKI)in lung adenocarcinoma patients,and the correlation between treatment and prognosis of advanced lung adenocarcinoma.Methods The data of patients with stageⅢB-Ⅳlung adenocarcinoma diagnosed by pathological examination were collected.The age,sex,smoking,the state of EGFR mutation,peripheral blood T-lymphocytes subsets,treatment patterns,objective response rate(ORR)and progression-free survival(PFS)of the patients were observed.Results The EGFR detection rate was 65.1%(127/195)in advanced lung adenocarcinoma patients in Yunnan Province.The EGFR mutation was more common in female and non-smoking patients(P=0.003;P=0.001).EGFR-TKI application rate in lung adenocarcinoma patients with EGFR mutation was 93.8%(61/65).The ORR and PFS of patients treated with EGFR-TKI were better than those treated with chemotherapy(72.1%vs 41.9%,P<0.001;10.7 months vs 7.3 months,P=0.038).Multivariate analysis showed that EGFR mutation and brain metastasis were prognostic factors of PFS (P=0.009;P=0.014). The overall survival data were not yet mature. A comparison of peripheral blood T-lymphocytesubsets before and after treatment showed that chemotherapy or targeted therapy did not seriously impair the patient's immune function.Conclusions EGFR-TKI targeted therapy is the first choice for advanced lung adenocarcinoma patients with positive EGFR mutation inYunnan Province. EGFR mutation can be used as a predictive and prognostic factor for advanced lung adenocarcinoma patients.