奥希替尼治疗T790M阳性突变肺腺癌患者预后的影响因素分析

An analysis of influencing factors for prognosis of lung adenocarcinoma patients with T790M positive mutation treated with osimertinib

目的分析奥希替尼治疗T790M阳性突变肺腺癌患者预后的影响因素。方法采用一代表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(EGFR-TKI)治疗298例肺腺癌患者发生T790M阳性突变后,使用三代EGFR-TKI奥希替尼进行治疗。采用Kaplan-Meier法进行生存分析,log-rank检验比较生存率,Cox比例风险回归模型分析奥希替尼治疗后预后的影响因素。结果298例患者奥希替尼治疗的中位无进展生存期(mPFS)为11.0个月。KPS评分<80分患者的mPFS短于KPS评分≥80分患者(P<0.01),初治前EGFR基因突变类型罕见突变18/20患者的mPFS短于经典突变19/21患者(P<0.01),肝转移患者的mPFS短于无肝转移患者(P<0.01),远处转移器官数<3个患者的mPFS长于远处转移器官数≥3个的患者(P<0.01),原发肿瘤既往手术患者的mPFS长于无既往手术患者(P<0.05)。KPS评分以及初治前EGFR基因突变类型是奥希替尼治疗T790M阳性突变肺腺癌患者mPFS的独立影响因素(P<0.05)。结论KPS评分和初治前EGFR突变类型是影响奥希替尼治疗T790M阳性突变肺腺癌患者的独立预后因素。

Objective To analyze the influencing factors for the prognosis of lung adenocarcinoma patients with T790M positive mutation treated with osimertinib.Methods A total of 298 patients with lung adenocarcinoma treated with first-generation epidermal growth factor receptor(EGFR)tyrosine kinase inhibitors(EGFR-TKI)happened T790M positive mutation and treated with three generations of EGFR-TKI osimertinib.Survival analysis was performed by Kaplan-Meier method,and the survival rate was compared by log-rank test.The influencing factors for the prognosis after osimertinib treatment were analyzed by Cox proportional hazard regression model.Results The median progression free survival(mPFS)of 298 patients treated with osimertinib was 11.0 months.The mPFS of the patients with KPS score 80 points was shorter than that of the patients with KPS score≥80 points(P<0.01).The mPFS of the patients with EGFR gene mutation type before initial treatment rare mutation 18/20 was shorter than that of the patients with classical mutation 19/21(P<0.01).The mPFS of the patients with liver metastasis was shorter than that of the patients without liver metastasis(P<0.01).The mPFS of the patients with the numbers of distant metastatic organ 3 was longer than that of the patients with the numbers of distant metastatic organ≥3(P<0.01).The mPFS was longer in the patients with previous surgery for primary tumors than that in the patients without previous surgery(P<0.05).KPS score and EGFR gene mutation type before initial treatment were the independent factors for mPFS in lung adenocarcinoma patients with T790M positive mutation treated with osimertinib(P<0.05).Conclusion KPS score and EGFR mutation type before initial treatment are the independent prognostic factors for lung adenocarcinoma patients with T790M positive mutation treated with osimertinib.