晚期NSCLC患者接受吉非替尼靶向联合化疗治疗疗效及无进展生存预测因子研究

Efficacy of Gefitinib Targeted Therapy Combined with Chemotherapy and Predictors of Progression-Free Survival in Patients with Advanced NSCLC

目的:探究晚期非小细胞肺癌(NSCLC)患者接受吉非替尼靶向联合化疗治疗疗效及分析无进展生存期(PFS)预测因子。方法:回顾性分析于2019年1月至2021年12月期间在本院诊治的255例晚期NSCLC患者的临床资料,依据治疗方式将研究对象分为对照组(n=78)、联合组(n=177),对照组行常规化疗治疗,联合组行吉非替尼靶向联合化疗治疗。比较对照组和联合组近期疗效,采用Kaplan-Meier绘制两组PFS生存曲线以评估远期疗效,采用单因素和多因素COX回归分析联合组PFS的预测因子。结果:与对照组相比较,联合组客观缓解率(ORR)(68.36%vs55.13%)、疾病控制率(DCR)(97.14%vs87.18%)均更高(P<0.05);联合组中位PFS为14个月,对照组相中位PFS 9个月,Log-rank检验比较显示两组生存曲线有差别(95%CI:1.12~2.17,Log-rank检验χ^(2)=7.624,P=0.006);单因素分析显示,年龄、胸腔积液、合并骨转移、表皮生长因子受体(EGFR)突变、肿瘤分期、肿瘤直径、乳酸脱氢酶(LDH)水平、近期疗效与PFS具有相关性(P<0.05);多因素COX回归分析显示,胸腔积液(95%CI:1.025~1.166)、EGFR突变(95%CI:1.018~1.067)、肿瘤分期ⅣA-ⅣB(95%CI:1.021~1.140)、肿瘤直径≥5cm(95%CI:1.039~1.159)、LDH>245U/L(95%CI:1.055~1.150)、近期疗效(95%CI:1.548~4.752)为PFS的独立预测因子(P<0.05)。结论:吉非替尼靶向联合化疗治疗晚期NSCLC的近期效果较佳,且能够有效改善患者远期预后。胸腔积液、肿瘤分期、肿瘤直径、LDH水平、近期疗效等为吉非替尼靶向联合化疗治疗晚期NSCLC患者PFS的独立预测因子。

Objective:To investigate the efficacy of gefitinib targeted therapy combined with chemotherapy in patients with advanced non-small cell lung cancer(NSCLC)and to analyze the predictors of progression-free survival(PFS).Methods:The clinical data of 255 patients with advanced NSCLC who were diagnosed and treated in the hospital were retrospectively analyzed from January 2019 to December 2021.The above subjects were divided into control group(n=78)and combined group(n=177)by the treatment methods.The control group was treated with conventional chemotherapy,while the combined group received gefitinib targeted therapy combined with chemotherapy.The short-term efficacy was compared between the control group and the combined group.Kaplan-Meier was used to draw the PFS survival curve of the two groups to evaluate the long-term efficacy.Univariate analysis and multivariate COX regression analysis were used to analyze the predictors of PFS in the combined group.Results:Compared with the control group,the objective response rate(ORR)(68.36%vs 55.13%)and disease control rate(DCR)(97.14%vs 87.18%)in the combined group were higher(P<0.05).The median PFS in the combined group was 14 months and that in the control group was 9 months.Log-rank test revealed that the survival curve in the two groups was different(95%CI:1.12~2.17,Log-rank testχ^(2)=7.624,P=0.006).Univariate analysis suggested that age,pleural effusion,bone metastasis,epidermal growth factor receptor(EGFR)mutation,tumor staging,tumor diameter,lactate dehydrogenase(LDH)level and short-term efficacy were correlated with PFS(P<0.05).Multivariate COX regression analysis revealed that pleural effusion(95%CI:1.025~1.166),EGFR mutation(95%CI:1.018~1.067),tumor stage IV A-IV B(95%CI:1.021~1.140),tumor diameter≥5cm(95%CI:1.039~1.159),LDH>245U/L(95%CI:1.055~1.150)and optimal efficacy(95%CI:1.548~4.752)were independent predictors of PFS(P<0.05).Conclusion:Gefitinib targeted therapy combined with chemotherapy has a good short-term effect in the treatment of advanced NSCLC,and can effectively improve the long-term prognosis of patients.Pleural effusion,tumor staging,tumor diameter,LDH level and optimal efficacy are independent predictors of PFS in patients with advanced NSCLC receiving gefitinib targeted therapy combined with chemotherapy.