基于ERCC1与RRM1和TEKT4基因联合检测的Ⅲ/Ⅳ期非小细胞肺癌化疗效果及安全性分析

Chemotherapy efficacy and safety of stage Ⅲ/Ⅳ non-small cell lung cancer based on combined detection of ERCC1,RRM1 and TEKT4 gene

目的 分析基于核苷酸切除修复交叉互补基因1(ERCC1)、核苷酸还原酶亚单位M1(RRM1)、TEKT4基因联合检测的Ⅲ/Ⅳ期非小细胞肺癌化疗效果及安全性。方法 选取2020年1月—12月许昌市中心医院呼吸科经病理确诊的Ⅲ/Ⅳ期非小细胞肺癌初治患者158例为研究对象,将其采用简单随机法分为试验组和对照组,每组均79例。对照组患者根据CSCO原发性肺癌诊疗指南选取紫杉醇/多西他赛/长春瑞滨联合顺铂、吉西他滨联合顺铂两种化疗方案中任何一种治疗,试验组首先采用飞行时间质谱(MALDI-TOF-MS)分析法测定患者肿瘤组织或者血液内ERCCl、RRMl基因多态性及TEKT4基因突变情况,根据表达水平选择治疗方案。比较两组化疗前后的肿瘤标志物水平、功能状态,并比较两组的临床疗效、不良反应情况、生存情况。结果 化疗后试验组的各项肿瘤标志物水平均低于对照组,差异统计学有意义(P<0.05)。试验组患者化疗后的功能状态改善率为50.00%,明显高于对照组的31.75%,试验组患者化疗后的客观缓解率为80.00%、疾病控制率为95.71%,明显高于对照组的客观缓解率50.80%和疾病控制率90.48%,差异统计学有意义(P<0.05)。试验组患者化疗后的剧烈呕吐、骨髓抑制发生率低于对照组,差异统计学有意义(P<0.05)。两组患者均随访6个月,试验组患者的生存率为94.49%(75/79),对照组的生存率为83.54%(66/79),差异统计学有意义(χ^(2)=7.125,P<0.05)。结论 基于ERCC1、RRM1、TEKT4基因联合检测的Ⅲ/Ⅳ期非小细胞肺癌化疗能够促进患者肿瘤标志物水平变化,促进患者的功能状态改善和临床疗效改善,减少不良反应,改善生存状况。

Objective To analyze the efficacy and safety of chemotherapy based on nucleotide excision repair cross com-plementary gene 1(ERCC1),nucleotide reductase subunit MI(RRMI)and TEKT4 gene in stage II/IV non-small cell lung cancer.Methods A total of 158 patients with stage II/IV non-small cell lung cancer diagnosed pathologi-cally in respiratory department of our hospital from January 2020 to December 2020 were selected as the research ob-jects.They were divided into experimental group and control group by simple random method,with 79 cases in each group.Patients in the control group were treated with either of two chemotherapy regimens-paclitaxel/docetaxel/vi-norelbine combined with cisplatin or gemcitabine combined with cisplatin according to CSCO guidelines for the diagnosis and treatment of primary lung cancer.In the experimental group,time of flight mass spectrometry(MALDI-TOF-MS)was used to determine ERCCI,RRMI gene polymorphism and TEKT4 gene mutation in tumor tissue or blood of pa-tients,and the treatment plan was selected according to the expression level.The levels of tumor markers and functional status before and after chemotherapy were compared between the two groups,and the clinical efficacy,adverse reactions and survival were compared between the two groups.Results After chemotherapy,the levels of tumor markers in the improvement rate of functional status of patients in the experimental group after chemotherapy was 50.00%,which was significantly higher than that of the control group(31.75%).The objective response rate and disease control rate of patients in the experimental group after chemotherapy were 80.00%and 95.71%,which were significantly higher than those of the control group(50.80%and 90.48%),the difference was significant(P<0.05).The incidence of severe vomiting and myelosuppression after chemotherapy in the experimental group was lower than that in the control group,and the differences were significant(P<0.05).The survival rate of the experimental group was 94.49%(75/79),and that of the control group was 83.54%(66/79),and the difference was significant(χ^(2)=7.125,P<0.05).Conclusion Chemotherapy based on the combined detection of ERCC1,RRM1 and TEKT4 genes in stage II/IV NSCLC can promote the changes of tumor markers,promote the improvement of functional status and clinical efficacy,reduce adverse reactions,and improve the survival status of patients.