CAJ | 학술논문

目的：探讨 EGFR 基因状态对非小细胞肺癌（NSCLC）患者根治性术后辅助化疗及靶向治疗疗效的影响。方法选取2012年1月至2014年1月行根治手术治疗的高危ⅠB ~ⅢA 期 NSCLC 患者56例，送检肿瘤组织标本行EGFR 基因检测，根据 EGFR 检测结果及患者实际情况将56例患者分为三组：A 组为26例 EGFR 野生型患者，B 组为16例 EGFR 突变型患者，C 组为14例 EGFR 突变型患者。三组患者均自术后第三周起给予铂类＋紫杉醇方案化疗4周期，3周为一个周期；C 组患者在化疗结束两周后，给予口服表皮生长因子受体酪氨酸激酶抑制剂（ EGFR - TKIs）药物维持治疗。对比三组的临床特征，治疗毒副作用情况及6、12、18个月无疾病生存期（DFS）情况。结果①A 组和 B 组、A组和 C 患者的病理类型比较差异具有统计学意义（ P ﹤0.05），A 组中鳞癌多于腺癌，B 组和 C 组中腺癌多于鳞癌；②三组的化疗毒副作用主要表现为骨髓抑制和胃肠道反应，均较轻，未发生Ⅲ度以上反应，三组间比较差异无统计学意义（ P ﹥0.05）；C 组患者口服 TKIs 药物耐受性良好，仅5例患者发生Ⅰ度皮疹反应，3例患者发生Ⅰ度腹泻反应。③A 组患者6、12、18个月 DFS 分别为74.0%、60.2%、52.6%；B 组分别为100.0%、85.5%、76.1%；C 组分别为100.0%、100.0%、91.3%。三组6个月 DFS 比较差异无统计学意义（ P ﹥0.05）；12、18个月 DFS：C 组明显高于 A 组，差异具有统计学意义（ P ﹤0.05），A 组和 B 组、B 组和 C 比较差异无统计学意义（ P ﹥0.05）。结论 EGFR 基因状态可能会影响高危ⅠB -ⅢA 期 NSCLC 患者根治性术后辅助化疗的疗效；单纯采用化疗的 EGFR 突变型患者的 DFS 较野生型有延长的趋势；采用化疗＋靶向治疗的 EGFR 突变型患者的 DFS 较单纯采用化疗的野生型患者延长，较单纯采用化疗的突变型患者有延长的趋势。目的：探討 EGFR 基因狀態對非小細胞肺癌（NSCLC）患者根治性術後輔助化療及靶嚮治療療效的影響。方法選取2012年1月至2014年1月行根治手術治療的高危ⅠB ~ⅢA 期 NSCLC 患者56例，送檢腫瘤組織標本行EGFR 基因檢測，根據 EGFR 檢測結果及患者實際情況將56例患者分為三組：A 組為26例 EGFR 野生型患者，B 組為16例 EGFR 突變型患者，C 組為14例 EGFR 突變型患者。三組患者均自術後第三週起給予鉑類＋紫杉醇方案化療4週期，3週為一箇週期；C 組患者在化療結束兩週後，給予口服錶皮生長因子受體酪氨痠激酶抑製劑（ EGFR - TKIs）藥物維持治療。對比三組的臨床特徵，治療毒副作用情況及6、12、18箇月無疾病生存期（DFS）情況。結果①A 組和 B 組、A組和 C 患者的病理類型比較差異具有統計學意義（ P ﹤0.05），A 組中鱗癌多于腺癌，B 組和 C 組中腺癌多于鱗癌；②三組的化療毒副作用主要錶現為骨髓抑製和胃腸道反應，均較輕，未髮生Ⅲ度以上反應，三組間比較差異無統計學意義（ P ﹥0.05）；C 組患者口服 TKIs 藥物耐受性良好，僅5例患者髮生Ⅰ度皮疹反應，3例患者髮生Ⅰ度腹瀉反應。③A 組患者6、12、18箇月 DFS 分彆為74.0%、60.2%、52.6%；B 組分彆為100.0%、85.5%、76.1%；C 組分彆為100.0%、100.0%、91.3%。三組6箇月 DFS 比較差異無統計學意義（ P ﹥0.05）；12、18箇月 DFS：C 組明顯高于 A 組，差異具有統計學意義（ P ﹤0.05），A 組和 B 組、B 組和 C 比較差異無統計學意義（ P ﹥0.05）。結論 EGFR 基因狀態可能會影響高危ⅠB -ⅢA 期 NSCLC 患者根治性術後輔助化療的療效；單純採用化療的 EGFR 突變型患者的 DFS 較野生型有延長的趨勢；採用化療＋靶嚮治療的 EGFR 突變型患者的 DFS 較單純採用化療的野生型患者延長，較單純採用化療的突變型患者有延長的趨勢。
목적：탐토 EGFR 기인상태대비소세포폐암（NSCLC）환자근치성술후보조화료급파향치료료효적영향。방법선취2012년1월지2014년1월행근치수술치료적고위ⅠB ~ⅢA 기 NSCLC 환자56례，송검종류조직표본행EGFR 기인검측，근거 EGFR 검측결과급환자실제정황장56례환자분위삼조：A 조위26례 EGFR 야생형환자，B 조위16례 EGFR 돌변형환자，C 조위14례 EGFR 돌변형환자。삼조환자균자술후제삼주기급여박류＋자삼순방안화료4주기，3주위일개주기；C 조환자재화료결속량주후，급여구복표피생장인자수체락안산격매억제제（ EGFR - TKIs）약물유지치료。대비삼조적림상특정，치료독부작용정황급6、12、18개월무질병생존기（DFS）정황。결과①A 조화 B 조、A조화 C 환자적병리류형비교차이구유통계학의의（ P ﹤0.05），A 조중린암다우선암，B 조화 C 조중선암다우린암；②삼조적화료독부작용주요표현위골수억제화위장도반응，균교경，미발생Ⅲ도이상반응，삼조간비교차이무통계학의의（ P ﹥0.05）；C 조환자구복 TKIs 약물내수성량호，부5례환자발생Ⅰ도피진반응，3례환자발생Ⅰ도복사반응。③A 조환자6、12、18개월 DFS 분별위74.0%、60.2%、52.6%；B 조분별위100.0%、85.5%、76.1%；C 조분별위100.0%、100.0%、91.3%。삼조6개월 DFS 비교차이무통계학의의（ P ﹥0.05）；12、18개월 DFS：C 조명현고우 A 조，차이구유통계학의의（ P ﹤0.05），A 조화 B 조、B 조화 C 비교차이무통계학의의（ P ﹥0.05）。결론 EGFR 기인상태가능회영향고위ⅠB -ⅢA 기 NSCLC 환자근치성술후보조화료적료효；단순채용화료적 EGFR 돌변형환자적 DFS 교야생형유연장적추세；채용화료＋파향치료적 EGFR 돌변형환자적 DFS 교단순채용화료적야생형환자연장，교단순채용화료적돌변형환자유연장적추세。
Objective To explore the influence of status of EGFR gene on the effect of postoperative adjuvant chemotherapy and targeted therapy in patients with NSCLC. Methods A total of 56 patients with NSCLC inhigh - risk ⅠB - ⅢA stages received radical surgical treatment during January 2012 to January 2014 were allocated in this study,the expression of EGFR gene had been examined in specimens of tumor tissue. All these 56 patients were divided into three groups,according to the results of expression of EGFR and the actual situation of patients. 26 patients in group A were with wild type of EGFR,and 16 and 14 cases in group B and group C showed mutant type of EGFR,and patients in these three groups were given with 4 cycles of platinum plus paclitaxel chemotherapy sincethe third week after operation,3 weeks for a cycle. Patients in group C were given with oral administration of EGFR - TKIs for maintenance treatment of two weeks after the completion of chemotherapy. The clinical features,toxicity and 6,12 and 18 months disease free survival(DFS)rates were compared among patients in these 3 groups. Results ①The difference in pathologic types between group A and group B,group A and C was statistically significant( P ﹤ 0. 05),the number of patients with squamous carcinoma was more than that of adenocarcinoma in group A,andthe number of patients with adenocarcinoma was more than that of squa-mous carcinoma in group B and group C. ②The main side reactions of chemotherapy in patients of these three groups were suppression of bone mar-row and gastrointestinal reactions,all of them are lighter,without Ⅲ degree reactions,there was no statistically significant difference between these three groups(P ﹥ 0. 05). The tolerance of patients in group C during oral administration ofTKIs drug was good,only 5 patients had degree 1 rash reaction,3 patients had degree 1 diarrhea reaction. ③The 6,12 and 18 months DFS in patients of group A were 74. 0% ,60. 2% and 52. 6% re-spectively,they were 100. 0% ,85. 5% and 76. 1% respectively in patients of group B,and they were 100. 0% ,100. 0% and 91. 3% respectively in patients of group C. The difference in six months DFS among these three groups had no statistical significance( P ﹥ 0. 05). The difference in 12 and 18 months DFS:in patients of group A was significantly higher than that of patients in group Cwith statistical significance( P ﹤ 0. 05),but the difference between patients of group A and group B,group B and group C was not statistically significant( P ﹥ 0. 05). Conclusion The sta-tus of EGFR gene may affect the effect of postoperative adjuvant chemotherapy in patients with NSCLC in high - riskⅠB - Ⅲ A stages. The DFS rates in patients with mutant type of EGFR received simple chemotherapy have tendency to extend in comparison with patients withwild type. The DFS rates in patients with mutant type of EGFR received chemotherapy plus targeted therapy will beextended in comparison with those patients with wild type received simple chemotherapy,and their DFS rates havetendency to be extended in comparison with those of patients with mutant type re-ceived simple chemotherapy.