CAJ | 학술논문

目的探讨肺鳞癌患者表皮生长因子受体( EGFR)突变及EGFR酪氨酸激酶抑制剂( EGFR-TKI)的疗效.方法收集2004年6月至2011年6月北京大学肿瘤医院胸部肿瘤内科治疗的79例晚期或术后复发的接受EGFR-TKI治疗的肺鳞癌患者,对其中67例患者进行组织或血浆EGFR19、21外显子突变检测,分析其与EGFR-TKI疗效的关系.结果 78例患者完成随访,1例失访(但可评价疗效及无进展生存期).79例中病情部分缓解6例(8％),稳定38例(48％),疾病控制率(DCR)为56％ (44/79),中位无进展生存期(mPFS)和中位总生存期(mOS)分别为3.7个月(95％ CI为2.0～5.0)和11.5个月(95％CI为6.6 ～14.2).67例进行基因突变检测的患者中,EGFR突变型31例,DCR为71％ (22/31),mPFS和mOS分别为6.3个月(95％C1为2.2～10.0)和13.5个月(95％CI为7.3～18.6).EGFR野生型36例,DCR为44％(16/36),mPFS和mOS分别为2.2个月(95％CI为1.1 ～4.0)和6.4个月(95％CI为4.0～12.0).在二线及以上治疗时接受EGFR-TKI治疗的EGFR突变患者中,厄洛替尼治疗组(17例)mPFS和mOS分别为7.9个月和15.8个月,吉非替尼治疗组(7例)均为6.3个月,两组比较差异无统计学意义(P＞0.05).Cox回归多因素分析结果显示,进行基因突变检测的67例患者的EGFR突变与无进展生存期、总生存期相关(均P＜0.05)；采用x2检验比较基因突变型与野生型两组的疗效,显示突变组进展风险明显低于野生组(P＜0.05).结论 EGFR基因突变的肺鳞癌患者仍可从EGFR-TKI治疗中获益,但疗效比EGFR突变的肺腺癌患者差.厄洛替尼的疗效优于吉非替尼,但差异无统计学意义.
목적 탐토폐린암환자표피생장인자수체( EGFR)돌변급EGFR락안산격매억제제( EGFR-TKI)적료효.방법 수집2004년6월지2011년6월북경대학종류의원흉부종류내과치료적79례만기혹술후복발적접수EGFR-TKI치료적폐린암환자,대기중67례환자진행조직혹혈장EGFR19、21외현자돌변검측,분석기여EGFR-TKI료효적관계.결과 78례환자완성수방,1례실방(단가평개료효급무진전생존기).79례중병정부분완해6례(8％),은정38례(48％),질병공제솔(DCR)위56％ (44/79),중위무진전생존기(mPFS)화중위총생존기(mOS)분별위3.7개월(95％ CI위2.0～5.0)화11.5개월(95％CI위6.6 ～14.2).67례진행기인돌변검측적환자중,EGFR돌변형31례,DCR위71％ (22/31),mPFS화mOS분별위6.3개월(95％C1위2.2～10.0)화13.5개월(95％CI위7.3～18.6).EGFR야생형36례,DCR위44％(16/36),mPFS화mOS분별위2.2개월(95％CI위1.1 ～4.0)화6.4개월(95％CI위4.0～12.0).재이선급이상치료시접수EGFR-TKI치료적EGFR돌변환자중,액락체니치료조(17례)mPFS화mOS분별위7.9개월화15.8개월,길비체니치료조(7례)균위6.3개월,량조비교차이무통계학의의(P＞0.05).Cox회귀다인소분석결과현시,진행기인돌변검측적67례환자적EGFR돌변여무진전생존기、총생존기상관(균P＜0.05)；채용x2검험비교기인돌변형여야생형량조적료효,현시돌변조진전풍험명현저우야생조(P＜0.05).결론 EGFR기인돌변적폐린암환자잉가종EGFR-TKI치료중획익,단료효비EGFR돌변적폐선암환자차.액락체니적료효우우길비체니,단차이무통계학의의.
Objective To investigate the frequency of epidermal growth factor receptor(EGFR) mutations and their correlation with the efficacy of tyrosine kinase inhibitors (EGFR-TKI) in advanced squamous cell lung cancer.Methods This retrospective study enrolled 79 patients with advanced squamous cell lung cancer who received EGFR-TKI at Department of Thoracic Medical Oncology in Peking University Cancer Hospital from June 2004 to June 2011.Among them,67 patients had tissue and/or plasma EGFR exon 19 and 21 mutation detection in order to make an analysis on the relationship between EGFR mutation and the TKI's effect.Results The disease control rate (DCR) was 56％ in all the patients.The median progression free survival (mPFS) and median overall survival (mOS) was 3.7 months (95％ CI:2.0 -5.0) and 11.5 months (95％ CI:6.6- 14.2),respectively.Of the 67 patients who received EGFR mutation detection,there were 31 patients harboring EGFR-mutation,for whom the DCR was 71％ (22/31),and mPFS and mOS was 6.3 months (95％ CI:2.2 - 10.0) and 13.5 months (95％ CI:7.3 -18.6) respectively.36 patients' EGFR status were wild type,for whom the DCR was 44％ (16/36),mPFS and mOS was 2.2 months ( 95 ％ CI:1.1 - 4.0 ) and 6.4 months ( 95 ％ CI:4.0 - 12.0 ).There were 17 patients who received erlotinib and 7 patients who received gefitinib as second or more line treatment.mPFS and mOS were 7.9 months and 15.8 months in the erlotinib group,respectively; and the mPFS and mOS were both 6.3 months in gefitinib group; the difference between the 2 groups did not reach statistical significance.Cox-regression analysis showed that EGFR mutation was significantly correlated with PFS and OS (P ＜ 0.05,respectively).EGFR mutation was significantly correlated with DCR by Chi-square test,P ＜0.05. Conclusions EGFR mutation was a predictor for advanced squamous cell lung cancer to EGFR-TKI.However,the effect was inferior in advanced squamous cell lung cancer as compared to lung adenocarcinoma.Erlotinib tended to be superior to gefitinib.