EGFR敏感突变ⅠA期浸润性肺腺癌术后辅助靶向治疗预后分析

Prognostic analysis of adjuvant targeted therapy for EGFR⁃positiveⅠA stage invasive lung adenocarcinoma after complete resection

目的分析ⅠA期浸润性肺腺癌切除术后EGFR敏感突变辅助性靶向治疗的疗效与安全性。方法选择2016年1月至2022年2月我院收治的肺腺癌患者82例,采用倾向性得分匹配(PSM)分为观察组34例,对照组34例,观察组肿瘤复发、转移前行EGFR⁃TKIs治疗,允许术后化疗。对照组复发前未行EGFR⁃TKIs治疗或仅接受化疗。分析临床特征、术后治疗方案、疗效、中位无病生存期(DFS)及安全性。结果观察组中位随访时间为22.43个月(8.57~56.39),对照组为22.16个月(7.14~51.00)。观察组复发3例(8.8%)、对照组复发10例(29.4%)。2年与3年DFS率观察组和对照组分别为97%vs.71%、89%vs.71%。观察组中位DFS未达到,对照组中位DFS为44.50个月(95%CI 24.51~64.49,P=0.014),HR=0.22(95%CI 0.06~0.81,P=0.023),术后EGFR⁃TKIs治疗复发风险降低78.0%。44.1%的患者出现靶向药物相关不良反应,主要的不良反应包括皮疹、肝功能异常,大部分患者可耐受。结论EGFR敏感突变ⅠA期浸润性肺腺癌患者术后辅以EGFR⁃TKIs治疗能延长DFS,降低复发风险。

Objective To analyze the efficacy and safety of adjuvant targeted therapy for EGFR⁃positive stageⅠA invasive lung adenocarcinoma after complete resection.Methods All of 82 patients with lung adenocarcinoma admitted in our hospital from January,2016 to February,2022 were selected and divided into observation group 34 cases and control group 34 cases by propensity score matching(PSM).The observation group was treated with EGFR⁃TKIs before tumor recurrence and metastasis,and postoperative chemotherapy was allowed.The control group was not treated with EGFR⁃TKIs or only received chemotherapy before recurrence.The clinical characteristics,postoperative treatment plan and efficacy,median disease⁃free survival(median DFS)and safety of the above patients were sorted and analyzed.Results After matching,the median follow⁃up time of observation group and control group were 22.43(8.57⁃56.39)months and 22.16(7.14⁃51.00)months.A total of 13 patients had endpoint events,including 3 patients(8.8%)in theobservation group and 10 patients(29.4%)in the control group.The 2⁃year DFS rate and 3⁃year DFS rate of the observation group and the control group were 97%vs.71%and 89%vs.71%respectively.The median DFS was undefined in the observation group.The median DFS of control groups was 44.50(24.51⁃64.49)months,P=0.014,HR=0.22(95%CI 0.06⁃0.81,P=0.023).44.1%of the patients had targeted drugrelated adverse reactions,the main adverse reactions included rash and liver function,which were tolerable in most patients.Conclusion Postoperative EGFR⁃TKIs therapy can prolong the survival time and reduce the risk of recurrence in patients with EGFR⁃positive IA stage invasive lung adenocarcinoma.