晚期肺腺癌IASLC分级和TTF-1蛋白表达与不同治疗方案疗效和患者预后的相关性

Correlation of IASLC Grade and TTF-1 Expression with Efficacy of Different Treatment Regimens and Prognosis in Patients with Advanced Lung Adenocarcinoma

目的探讨晚期肺腺癌IASLC分级和甲状腺转录因子1(thyroid transcription factor 1,TTF-1)蛋白表达与不同治疗方案疗效和患者预后的相关性。方法回顾性分析233例均接受EGFR基因检测的ⅢB/Ⅳ期肺腺癌患者的临床资料,免疫组化检测TTF-1蛋白的表达。结果114例EGFR敏感突变患者接受表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)一线治疗(EGFR突变组),119例EGFR无突变患者接受培美曲塞联合铂类化疗(EGFR非突变组)。233例肺腺癌患者中TTF-1阳性191例(82%),IASLC组织学分级低、EGFR敏感突变、不吸烟患者TTF-1的阳性表达率高于对应组。在EGFR突变组和非突变组中IASLC分级为Ⅲ级患者的客观缓解率(objective response rate,ORR)低于Ⅰ、Ⅱ级患者(P分别为0.023、0.024)。两组人群中高IASLC分级、TTF-1阴性患者无进展生存时间(progression-free survival,PFS)和总生存时间(overall survival,OS)均短于相应对照组。多因素分析结果显示,IASLC分级是影响两组PFS的独立因素,TTF-1表达是影响两组OS的独立因素。结论无论有无EGFR突变,IASLC分级和TTF-1蛋白是预测晚期肺腺癌患者PFS和OS的有效指标,IASLC分级高与培美曲塞基础化疗和EGFR-TKIs的疗效差有关。

Objective To analyze the correlation of IASLC grade and TTF-1 expression with efficacy of different treatment regimens and prognosis in patients with advanced lung adenocarcinoma.Methods A retrospective analysis was made on 233 cases of stageⅢB orⅣlung adenocarcinoma patients who received EGFR mutation test.The expression levels of TTF-1 were analyzed using immunohistochemical method.Results A total of 114 patients harboring EGFR mutations were treated with EGFR-TKIs,and 119 patients were treated with pemetrexed plus platinum.TTF-1 expression was positive in 191(82%)lung adenocarcinoma.Patients with low IASLC grade,non-smoking and EGFR mutation showed higher expression levels of TTF-1.In EGFR positive and negative group,lung adenocarcinoma of high IASLC grade had a lower objective response rate(ORR,P were 0.023,0.024)compared with the control adenocarcinoma.In both groups,patients of high IASLC grade and negative TTF-1 expression had a shorter progression-free survival(PFS)and overall survival(OS)compared with the control patients.Multivariate analysis of survival demonstrated that IASLC grade was independent prognostic factors for PFS,and TTF-1 was independent prognostic factors for OS of both groups.Conclusion IASLC grade and TTF-1 expression are good prognostic indicators for PFS and OS of patients with advanced lung adenocarcinoma.High IASLC grade is related to poor response of EGFR-TKIs and pemetrexed-based chemotherapy.