射频消融治疗在EGFR-TKI治疗后缓慢进展的非小细胞肺癌患者中的临床应用

Clinical application of radiofrequency ablation in patients with gradual progression of non-small cell lung cancer after EGFR-TKI treatment

目的探讨射频消融治疗在EGFR-TKI治疗后缓慢进展的非小细胞肺癌患者中的临床疗效。方法回顾性分析2015年1月至2019年12月在南通市第一人民医院介入科及呼吸科住院治疗的一线接受吉非替尼或厄洛替尼靶向治疗后出现缓慢进展的非小细胞肺癌患者66名。分为射频消融联合原EGFR-TKI组,奥希替尼组及化疗组,比较3组患者无进展生存期(PFS2)及总生存期(OS)并分析影响3组患者生存的相关因素。结果射频消融组PFS2为(6.73±1.81)月,奥希替尼组PFS2为(10.63±2.21)月,化疗组(4.54±1.41)月,(P<0.05)。射频消融组OS为(22.91±3.75)月,奥希替尼组OS为(25.42±4.64)月,化疗组OS为(18.92±2.61)月,(P<0.05)。多因素Cox回归分析,结果显示治疗方式、PFS2、ECOG评分影响患者生存时间的独立危险因素。结论存在EGFR基因突变的非小细胞肺癌患者,一线使用一代EGFR-TKI靶向治疗出现缓慢进展后,如果无T790M突变,可选择局部射频消融联合原EGFR-TKI继续治疗,延长患者的PFS及OS。

Objective To investigate the clinical efficacy of radiofrequency ablation in treatment of non-small cell lung cancer(NSCLC)patients with gradual progression after EGFR-TKI treatment.Methods From January 2015 to December 2019,a total of 66 NSCLC patients with gradual progress after targeted therapy of gefitinib or erlotinib were selected from the intervention department and respiratory department of Nantong First People's Hospital.The patients were divided into three groups:the radiofrequency ablation combined with original EGFR-TKI group,the oxitinib group and the chemotherapy group.The progression free survival 2(PFS2)and the overall survival(OS)of the three groups were compared,and the related factors affecting the OS were analyzed.Results The average progression free survival of the three groups were(6.73±1.81),(10.63±2.21)and(4.54±1.41)months respectively(P<0.05).The average OS of the three groups were(22.91±3.75),(25.42±4.64)and(18.92±2.61)months respectively(P<0.05).Multivariate cox regression analysis showed that treatment modalities,PFS2,and ECOG score were independent risk factors for OS.Conclusion In NSCLC patients with EGFR gene mutation,when there is a gradual progression after the first generation of EGFR-TKI targeted therapy,local radiofrequency ablation combined with original EGFR-TKI should be selected to prolong PFS and OS of patients without T790M mutation.