射波刀联合表皮生长因子受体-酪氨酸激酶抑制剂一线治疗表皮生长因子受体突变晚期非小细胞肺癌患者的临床研究

Clinical research of cyberknife combined epidermal growth factor receptor-tyrosine kinase inhibitor in the first line treatment of non-small cell lung cancer with epidermal growth factor receptor mutation

目的探讨射波刀(CK)联合表皮生长因子受体(EGFR)-酪氨酸激酶抑制剂(TKI)一线治疗EGFR突变晚期非小细胞肺癌(NSCLC)患者的疗效并分析影响因素。方法收集138例行CK联合EGFR-TKI一线治疗的EGFR突变晚期NSCLC患者的病历资料。采用Kaplan-Meier法分析不同因素对患者无进展生存期(PFS)和总生存期(OS)的影响。采用Cox回归模型分析患者预后的影响因素。结果138例患者中位随访时间为55.8个月,中位PFS、中位OS分别为26个月和47个月,12、24、36个月无进展生存率分别为77.5%、55.1%和36.0%,12、24、36、60个月总生存率分别为98.1%、82.0%、68.3%和28.3%。Cox回归分析结果显示,寡转移、年龄≥60岁、放靶异步治疗均是CK联合TKI一线治疗Ⅳ期NSCLC患者OS的独立保护因素。结论与单纯EGFR-TKI治疗比较,CK联合TKI一线治疗更能改善EGFR突变晚期NSCLC患者的预后,临床安全性好。寡转移、年龄≥60岁、放靶异步治疗均是CK联合TKI一线治疗Ⅳ期NSCLC患者OS的独立保护因素。

Objective To investigate the clinical efficacy and influencing factors of cyberknife(CK)combined with epidermal growth factor receptor-tyrosine kinase inhibitor(EGFR-TKI)in the first line treatment of non-small cell lung cancer(NSCLC)with EGFR mutation.Method Medical records of 138 NSCLC patients with EGFR mutation who re-ceived first line treatment of CK+EGFR-TKI were collected.The influencing of different factors on progression-free sur-vival(PFS)and overall survival(OS)were analyzed by Kaplan-Meier method and influencing factors of prognosis were analyzed by Cox regression model.Result The median follow-up time of 138 cases was 55.8 months,the median PFS and OS were 26 months and 47 months respectively.The PFS rates of patients in 12,24 and 36 months were 77.5%,55.1%and 36.0%respectively,and corresponding OS rates in 12,24,36,60 months were 98.1%,82.0%,68.3%and 28.3%,respectively.Cox regression analysis showed that oligometastasis,age≥60 years,asynchronous treatment of CK and TKI were independent favorable factors of OS during the first line treatment of CK+TKI in stage IV NSCLC.Conclu-sion Compare with EGFR-TKI therapy,the first line treatment of CK+TKI can significantly improve the prognosis of advanced NSCLC patients with EGFR mutation,with good clinical safety.Oligometastasis,age≥60 years,asynchronous treatment of CK and TKI are independent favorable factors of OS during the first line treatment of CK+TKI in stage IV NSCLC.