冷冻消融联合抑制剂治疗EGFR敏感突变肺腺癌的临床疗效

Clinical efficacy of cryoablation combined with inhibitors in the treatment of EGFR-mutant lung adenocarcinoma

目的:探讨冷冻消融联合抑制剂治疗表皮生长因子受体(epidermal growth factor receptor,EGFR)敏感突变肺腺癌的临床疗效。方法:收集2019年12月至2020年12月在厦门医学院附属第二医院诊治的中晚期EGFR敏感突变的肺腺癌患者55例,根据不同的治疗方法分为单药组(30例)与联合组(25例),单药组给予EGFR-TKI治疗,联合组在单药组治疗的基础上给予氩氦刀冷冻消融治疗,记录患者治疗前血常规中淋巴结细胞总数、中性粒细胞计数、血小板计数,随访并记录患者最佳疗效及患者TKI治疗的无进展生存时间(progression-free survival,PFS)。结果:两组患者的治疗有效率差异无统计学意义,但联合组的中位PFS(18个月)长于单药组(10.5个月),差异具有统计学意义(P<0.05)。对可能影响患者TKI治疗PFS的各因素应用COX比例风险模型进行分析,氩氦刀冷冻消融治疗、肺肿块>4 cm为患者发生疾病进展的危险因素;氩氦刀冷冻治疗的B值为1.270,而肿块>4 cm的B值为-1.003。进一步分析氩氦刀冷冻治疗的介入时间,在TKI治疗开始时与TKI治疗病变稳定后给予氩氦刀冷冻治疗,两者差异无统计学意义(P>0.05)。结论:氩氦刀冷冻消融治疗联合EGFR-TKI一线治疗EGFR敏感突变肺腺癌患者能延长患者的PFS,肺肿块>4 cm对患者TKI治疗的PFS不利。

Objective:To investigate the clinical efficacy of cryoablation combining with inhibitors in the treatment of epidermal growth factor receptor(EGFR)sensitive mutant lung adenocarcinoma.Methods:Clinical data of 55 patients with advanced lung cancer diagnosed and treated in the Second Affiliated Hospital of Xiamen Medical College from December 2019 to December 2020 were collected.55 patients were divided into the combination group(n=25)and the monotherapy group(n=30)according to different treatment methods.The monotherapy group was given EGFR-TKI treatment,while the patients in the combination group were treated with cryoablation on the basis of EGFR-TKI treatment.The counts of total lymphocyte,neutrophil and platelet in routine blood test of all patients before treatment were recorded,then the optimal effect and the progression-free survival(PFS)of TKI therapy were recorded in the follow-up.Results:Overall effective rates of the two groups were not statistically different.However,the median PFS of the combination group was 18 months,which was much longer than 10.5 months of the monotherapy group(P<0.05).Moreover,a Cox proportional hazards model was used to evaluate the potential influencing factors of PFS in TKI therapy.Lung mass greater than 4cm was the hazard factor to disease progression of patients with lung adenocarcinoma.The B value of argon-helium knife cryotherapy was 1.270,which had better benefits for the PFS.However,the diameter of mass greater than 4cm was adverse to the PFS of patients treated with TKI,given that the B value was-1.003.Further to analyze the intervention time of argon-helium knife cryotherapy,no statistical significance was found between the groups given argon-helium knife cryoablation treatment combined with TKI therapy,regardless of the use of TKI at the beginning or the lung mass getting stable after TKI treatment(P>0.05).Conclusion:Argon-helium knife cryoablation combined with EGFR-TKI to treat EGFR-mutant lung adenocarcinoma could prolong the patients’PFS.The diameter of lung mass greater than 4cm was the adverse factor to the PFS of patients treated with TKI.