晚期初治肺腺癌患者接受含铂联合化疗后生存获益影响因素及HER 2基因状态的影响

Influencing factors of survival benefit in patients with advanced lung adenocarcinoma treated by platinum containing chemotherapy and influence of HER2 gene status on prognosis

目的探讨晚期初治肺腺癌患者接受含铂联合化疗后生存获益影响因素及HER2基因状态的影响。方法回顾性分析河南科技大学附属许昌市中心医院2015年1月至2019年12月收治接受含铂联合化疗期初治肺腺癌患者共424例临床资料,分析HER2基因状态与临床特征关系及对临床疗效的影响,评价患者接受含铂联合化疗后生存获益影响因素。结果424例患者中男252例,女172例;中位年龄57.0(32.0~75.0)岁;根据HER2基因状态划分,突变型12例,野生型412例;接受含铂联合化疗中位周期数为6.0(2.0~14.0)个;治疗后客观缓解率(ORR)和疾病控制率(DCR)分别为22.64%(96/424),71.70%(324/424)。HER2基因状态与晚期初治肺腺癌患者年龄、性别及既往吸烟情况有关(P<0.05);HER2突变组接受含铂联合化疗后ORR和DCR均显著高于HER2野生组(P<0.05)。单因素分析结果显示,合并脑转移、给予维持化疗及HER2基因型与晚期初治肺腺癌患者接受含铂联合化疗后生存获益有关(P<0.05);Cox比例风险回归模型多因素分析结果证实,存在HER2基因突变是晚期初治肺腺癌患者接受含铂联合化疗后无进展生存期(PFS)独立危险因素(P<0.05)。结论晚期初治肺腺癌患者接受含铂联合化疗后生存获益与HER2基因突变独立相关,HER2突变型人群接受含铂联合化疗PFS更长。

【Objective】To investigate the influencing factors of survival benefit in patients with advanced lung adenocarcinoma treated by platinum containing chemotherapy and influence of HER2 gene status on prognosis.【Methods】Clinical data of 424 patients with advanced lung adenocarcinoma treated by platinum containing chemotherapy were retrospectively chosen in the period from January 2015 to December 2019 in our hospital.The relationship between HER2 gene status and clinical characteristics and its influence on clinical efficacy were analyzed and the influencing factors of survival benefit after platinum containing chemotherapy were evaluated.【Results】There were 252 males and 172 females with median age of 57.0 years in 424 cases;128 cases were mutation type and 296 cases were wild type.The median cycle number of platinum containing chemotherapy was 6.0.The objective response rate(ORR)and disease control rate(DCR)after treatment were 22.64%(96/424)and 71.70%(324/424),respectively.HER2 gene status was associated with age,gender and smoking status in patients with advanced lung adenocarcinoma(P<0.05).The ORR and DCR of HER2 mutation group were significantly higher than HER2 wild group after platinum containing chemotherapy(P<0.05).Univariate analysis showed that brain metastases,maintenance chemotherapy and HER2 genotypes were associated with survival benefits in patients with advanced lung adenocarcinoma treated by platinum based chemotherapy(P<0.05).Multivariate analysis of Cox proportional hazard regression model confirmed that HER2 gene mutation was an independent risk factor for progression-free survival(PFS)in patients with advanced lung adenocarcinoma treated by platinum containing chemotherapy(P<0.05).【Conclusion】Survival benefit of patients with advanced lung adenocarcinoma treated by platinum based chemotherapy is independently associated with HER2 gene mutation and patients with HER2 mutation treated by platinum containing chemotherapy have longer PFS.