CAJ | 학술논문

目的探讨应用培美曲塞为基础方案化疗的非小细胞肺癌(NSCLC)患者表皮生长因子受体(EGFR)基因突变与生存的关系.方法回顾性分析2009年4月至2012年9月中国医学科学院肿瘤医院146例应用培美曲塞为基础方案化疗的NSCLC患者,其中培美曲塞为基础方案一线化疗患者79例(培美曲塞一线治疗组),培美曲塞一线化疗后培美曲塞维持治疗的患者38例(培美曲塞维持治疗组),培美曲塞一线化疗后应用酪氨酸激酶抑制剂(TKI)维持治疗的患者29例(TKI维持治疗组).对不同治疗组的中位无进展生存期(PFS)进行分析,对培美曲塞一线治疗组及培美曲塞维持治疗组不同EGFR突变状态患者的中位PFS进行比较.结果培美曲塞一线治疗组,培美曲塞维持治疗组和TKI维持治疗组的中位PFS分别为4.6个月(95％ CI:2.8 ～6.4),9.8个月(95％ CI:6.1～13.5)和14.5个月(95％ CI:11.8～17.2)(P =0.000).培美曲塞一线治疗组EGFR突变、无突变及突变情况不详NSCLC患者中位PFS分别为5.2个月(95％ CI:2.8 ～7.7),4.0个月(95％ CI:0～10.8)和4.6个月(95％ CI:3.4 ～5.8) (P =0.661).培美曲塞维持治疗组EGFR突变、无突变及突变情况不详NSCLC患者的中位PFS分别为8.5个月(95％ CI:4.0～13.1),12.6个月(95％ CI:11.6 ～13.7)和8.0个月(95％ CI:5.8 ～ 10.3)(P =0.468).结论不同EGFR突变状态下应用培美曲塞为基础方案一线化疗的NSCLC患者生存无明显差异.无论是何种EGFR突变状态,TKI维持治疗较培美曲塞维持治疗均有生存优势.
목적 탐토응용배미곡새위기출방안화료적비소세포폐암(NSCLC)환자표피생장인자수체(EGFR)기인돌변여생존적관계.방법 회고성분석2009년4월지2012년9월중국의학과학원종류의원146례응용배미곡새위기출방안화료적NSCLC환자,기중배미곡새위기출방안일선화료환자79례(배미곡새일선치료조),배미곡새일선화료후배미곡새유지치료적환자38례(배미곡새유지치료조),배미곡새일선화료후응용락안산격매억제제(TKI)유지치료적환자29례(TKI유지치료조).대불동치료조적중위무진전생존기(PFS)진행분석,대배미곡새일선치료조급배미곡새유지치료조불동EGFR돌변상태환자적중위PFS진행비교.결과 배미곡새일선치료조,배미곡새유지치료조화TKI유지치료조적중위PFS분별위4.6개월(95％ CI:2.8 ～6.4),9.8개월(95％ CI:6.1～13.5)화14.5개월(95％ CI:11.8～17.2)(P =0.000).배미곡새일선치료조EGFR돌변、무돌변급돌변정황불상NSCLC환자중위PFS분별위5.2개월(95％ CI:2.8 ～7.7),4.0개월(95％ CI:0～10.8)화4.6개월(95％ CI:3.4 ～5.8) (P =0.661).배미곡새유지치료조EGFR돌변、무돌변급돌변정황불상NSCLC환자적중위PFS분별위8.5개월(95％ CI:4.0～13.1),12.6개월(95％ CI:11.6 ～13.7)화8.0개월(95％ CI:5.8 ～ 10.3)(P =0.468).결론 불동EGFR돌변상태하응용배미곡새위기출방안일선화료적NSCLC환자생존무명현차이.무론시하충EGFR돌변상태,TKI유지치료교배미곡새유지치료균유생존우세.
Objective To explore the association between different epidermal growth factor receptor (EGFR) mutation status and survival in pemetrexed-based chemotherapy for advanced non-small-cell lung cancer (NSCLC).Methods A retrospective cohort study was performed to assess 146 patients with advanced NSCLC at Cancer Institute/Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College.The first-line regimens included pemetrexed based chemotherapy (pemetrexed first-line therapy group,n =79),pemetrexed based chemotherapy plus pemetrexed maintenance chemotherapy (pemetrexed maintenance therapy group,n =38) and pemetrexed based chemotherapy plus tyrosine kinase inhibitors (TKI) maintenance therapy (TKI maintenance therapy group,n =29).Median progression-free survival (PFS) was determined.For comparison,median PFS was evaluated for EGFR-positive,EGFR-negative versus EGFR mutation unknown NSCLC patients in first-line pemetrexed therapy and pemetrexed maintenance therapy groups.Results The median PFS was 4.6 (95％ CI:2.8-6.4),9.8 (95％ CI:6.1-13.5) and 14.5 (95％ CI:11.8-17.2) months in pemetrexed first-line therapy,pemetrexed maintenance therapy and TKI maintenance therapy groups respectively (P =0.000).No difference existed in PFS for pemetrexed first-line therapy group with a median PFS of 5.2 (95 ％ CI:2.8-7.7),4.0 (95 ％ CI:0-10.8) and 4.6 (95％ CI:3.4-5.8) months respectively (P =0.661).Among EGFR-positive,EGFRnegative and EGFR mutation status unknown patients in pemetrexed maintenance therapy group,the median PFSwas8.5 (95％CI:4.0-13.1),12.6 (95％CI:11.6-13.7) and 8.0 (95％CI:5.8-10.3) mnonths with no significant statistical difference (P =0.468).Conclusions No significant difference exists in survival between different EGFR mutation status for pemetrexed based first-line chemotherapy.And TKI maintenance therapy is associated with better survival than pemetrexed maintenance therapy regardless of EGFR status.