基于肿瘤分子特征胶质母细胞瘤患者对肿瘤电场治疗敏感性预测价值探讨

Predictive value of tumor molecular characteristics for sensitivity to tumor-treating field therapy in glioblastoma patients

目的 探究肿瘤电场治疗(TTFields)的抗肿瘤效用及可预测患者对TTFields治疗响应的肿瘤分子特征。方法 回顾性分析华山医院2018年8月—2023年6月收治的100例接受过TTFields治疗的新诊断的胶质母细胞瘤(ndGBM)患者的临床资料和基因检测数据,另选择195例未接受电场治疗的ndGBM作为对照组。采用Kaplan-Meier法分析TTFields治疗组和对照组患者生存差异;组间比较采用Log-rank检验。采用多因素Cox回归分析探讨TTFields治疗效果的影响因素。结果 TTFields治疗组中位总生存期(OS)23.0个月(95%CI:17-NA),对照组中位OS为15.1个月(95%CI:13~18)。TTFields治疗组中位无进展生存期(PFS)17个月(95%CI:12-NA),相比对照组中位PFS为12个月(95%CI:9~12)。多因素Cox回归分析结果显示,PTEN突变、EGFR扩增对TTFields治疗组的PFS(PTEN突变,HR=0.15,95%CI=0.034~0.63;EGFR扩增,HR=5.67,95%CI=1.455~22.05)的影响有统计学意义(均P<0.05)。TERT突变对TTFields治疗组OS(TERT突变,HR=3.96,95%CI=1.308~12.0)的影响有统计学意义(P<0.05)。结论 TTFields治疗可以显著延长患者的生存期。PTEN突变,EGFR扩增是独立预测患者对TTFields PFS的潜在分子标志物,TERT启动子突变是预测TTFields患者OS的潜在标志物。

Objective To explore the antitumor efficacy of tumor-treating fields(TTFields)and identify potential molecular markers for predicting patient response to TTFields therapy.Methods The clinical and genetic data of 100 newly diagnosed glioblastoma(ndGBM)patients who underwent TTFields therapy at Huashan Hospital from August 2018 to June 2023 were analyzed retrospectively.An additional control group of 195 ndGBM patients who did not undergo TTFields therapy was selected.Kaplan-Meier analysis was utilized to assess survival differences between the TTFields therapy group and the control group,with intergroup comparisons performed using the log-rank test.Multivariate Cox regression analysis was employed to investigate factors influencing the efficacy of TTFields therapy.Results In the TTFields therapy group,the median overall survival(OS)was 23.0 months(95%CI=17-NA),whereas the control group exhibited a median OS of 15.1 months(95%CI=13-18).Median progression-free survival(PFS)in the TTFields therapy group was 17 months(95%CI=12-NA),compared to 12 months(95%CI=9~12)in the control group.Multivariate Cox regression analysis results revealed statistically significant effects of PTEN mutation(HR=0.15,95%CI:0.034-0.63)and EGFR amplification(HR=5.67,95%CI=1.455-22.05)on PFS in the TTFields therapy group(both P<0.05).Additionally,TERT mutation significantly influenced OS in the TTFields therapy group(HR=3.96,95%CI=1.308-12.0,P<0.05).Conclusions TTFields therapy significantly prolongs patient survival.PTEN mutation and EGFR amplification emerge as independent potential molecular markers for predicting PFS in response to TTFields therapy,while TERT mutation serves as a potential marker for predicting OS in TTFields-treated patients.