EGFR罕见突变非小细胞肺癌患者的临床疗效分析

Clinical Efficacy Analysis of Patients with rare EGFR mutation in Non-small Cell Lung Cancer

目的探讨表皮生长因子受体(EGFR)罕见突变非小细胞肺癌(NSCLC)患者的临床疗效。方法对连云港市第一人民医院2015年9月至2021年12月所有行EGFR基因检测的NSCLC患者的病历资料进行回顾性分析。分析罕见突变临床病理特征,不同治疗方法及不同突变类型对患者治疗的影响。结果共有2113例NSCLC患者行EGFR检测,排除重复项及T790M耐药突变后,共纳入1790例患者,其中突变患者771例,罕见突变81例。在突变患者中,罕见突变的发生与吸烟相关(P<0.01)。与性别、年龄分段、分期、病理相关性分析差异无统计学意义(P>0.05)。总的罕见突变患者中,接受一线化疗与靶向治疗的客观缓解率(ORR),疾病控制率(DCR),中位无进展生存期(mPFS)差异无统计学意义(P>0.05)。单一罕见突变患者中,接受一线化疗与靶向治疗的ORR、DCR差异无统计学意义(P>0.05),mPFS差异有统计学意义(P<0.05)。单一罕见突变和复合突变接受一线靶向治疗后ORR、DCR差异无统计学意义(P>0.05),mPFS差异有统计学意义(P<0.05)。结论在EGFR突变患者中罕见突变的发生可能与吸烟有关,单一罕见突变患者中对比一线化疗与靶向治疗,化疗可获得更长的mPFS。复合突变患者和单一罕见突变患者分别接受一线靶向治疗后,复合突变可获得更长的mPFS。

Objective To investigate the clinical efficacy of epidermal growth factor receptor(EGFR)mutation in patients with non-small cell lung cancer(NSCLC).Methods A retrospective analysis was performed on all patients with non-small cell lung cancer who underwent EGFR gene detection from September 2015 to December 2021 in the First People's Hospital of Lianyungang.The clinicopathologic features of rare mutations,the influence of different treatment methods and different mutation types on the treatment of patients were analyzed.Results A total of 2113 NSCLC patients underwent EGFR test.After excluding duplications and T790M drug-resistant mutation,there were 1790 patients.We classified 771 cases with mutation patients,which including 81 cases of rare mutation and 690 cases of common mutation patients.Among mutation patients,the occurrence of rare mutations was correlated with smoking,which was statistically significant(P<0.01).It was correlated with gender,age group,stage,pathology showed no statistical significance(P>0.05).There was no significant difference in ORR,DCR,mPFS between first-line chemotherapy and targeted therapy in patients with rare mutations which including single rare mutations and complex mutations(P>0.05).There was no significant difference in ORR,DCR between patients receiving first-line chemotherapy and targeted therapy with single rare mutations(P>0.05),while mPFS between them was statistically significant(P<0.05).There was no significant difference in ORR,DCR between single rare mutation and complex mutation receiving first-line targeted therapy(P>0.05),while mPFS was statistically significant(P<0.05).Conclusions The occurrence of rare mutations in patients with EGFR mutations may be related to smoking.In patients with a single rare mutation,chemotherapy is associated with longer mPFS compared with first-line chemotherapy and targeted therapy.Patients with complex mutations and single mutations after receiving first-line targeted therapy,longer mPFS were obtained by combination mutations.