摘要
目的观察EGFR-TP53共突变型晚期非小细胞肺癌患者采用EGFR-TKI靶向同步化疗、EGFR-TKI单靶治疗序贯化疗、EGFR-TKI单靶治疗序贯靶向联合化疗的效果及预后情况,探讨最佳治疗方案。方法2016年6月-2021年8月河南省人民医院诊治EGFR-TP53共突变型晚期非小细胞肺癌患者229例,其中一线EGFR-TKI单靶治疗111例(其中40例治疗后进展且无驱动基因突变),EGFR-TKI靶向同步化疗71例(靶向同步化疗组),EGFR-TKI靶向同步抗血管生成药物治疗32例,化疗15例。患者从治疗起始每2个周期行影像学等检查,采用RECIST标准评估疗效,至患者死亡或随访结束。采用单因素及多因素Cox回归分析EGFR-TP53共突变型晚期非小细胞肺癌患者预后的影响因素。40例一线EGFR-TKI单靶治疗后进展且无驱动基因突变者分为单靶序贯靶向联合化疗组24例和单靶序贯化疗组16例。比较靶向同步化疗组、单靶序贯靶向联合化疗组和单靶序贯化疗组客观缓解率、疾病控制率及治疗反应持续时间≥3个月比率;绘制Kaplan-Meier曲线,采用log-rank检验比较3组总生存期及无疾病进展生存期。结果一线治疗方案中EGFR-TKI靶向同步化疗是EGFR-TP53共突变型晚期非小细胞肺癌患者预后良好的影响因素(HR=0.597,95%CI:0.383~0.932,P=0.023)。靶向同步化疗组、单靶序贯靶向联合化疗组、单靶序贯化疗组客观缓解率(49.3%、54.2%、31.3%)、疾病控制率(97.2%、95.8%、87.5%)及治疗反应持续时间≥3个月比率(88.7%、91.7%、81.3%)比较差异均无统计学意义(P>0.05)。单靶序贯靶向联合化疗组中位总生存期(1542 d)、中位无疾病进展生存期(722 d)均长于靶向同步化疗组(826、487 d)、单靶序贯化疗组(515、278 d)(P<0.05),靶向同步化疗组中位无疾病进展生存期长于单靶序贯化疗组(χ^(2)=4.464,P=0.035),中位总生存期与单靶序贯化疗组比较差异无统计学意义(χ^(2)=0.278,P=0.598)。结论化疗协同EGFR
Objective To observe the efficacies of single-target EGFR-TKI combined with concurrent chemotherapy,single-target EGFR-TKI combined with sequential chemotherapy,and single-target EGFR-TKI combined with sequential single-target EGFR-TKI plus chemotherapy on advanced EGFR-TP53 co-mutant non-small-cell lung cancer(NSCLC)and their prognosis,and to investigate the optimal therapeutic schedule.Methods From June 2016 to August 2021,229patients with advanced EGFR-TP53 co-mutant NSCLC were diagnosed and treated in Henan Provincial People's Hospital,among whom 111 patients received first-line single-target EGFR-TKI therapy(including 40 progressive patients with no driver gene mutation),71 patients received single-target EGFR-TKI combined with concurrent chemotherapy(EGFR-TKI+concurrent chemotherapy group),32 patients received EGFR-TKI combined with anti-angiogenic therapy,and 15 patients received chemotherapy.Imaging examinations were performed every 2 cycles from the start of treatment,and the therapeutic efficacy was evaluated by using RECIST criteria until the patients died or the follow-up was ended.Univariate and multivariate Cox regression analyses were done to evaluate the influencing factors of the prognosis of patients with advanced EGFR-TP53 co-mutant NSCLC.Forty progressive patients with no driver gene mutation after first-line single-target EGFR-TKI therapy were divided into 24 patients receiving single-target EGFR-TKI combined with sequential EGFR-TKI plus chemotherapy(EGFR-TKI+sequential EGFR-TKI+chemotherapy group)and 16 patients receiving single-target EGFR-TKI combined with sequential chemotherapy(EGFR-TKI+sequential chemotherapy group).The objective response rate,disease control rate and percentage of patients with response duration≥3 months were compared among EGFR-TKI+concurrent chemotherapy group,EGFR-TKI+sequential EGFR-TKI+chemotherapy group and EGFR-TKI+sequential chemotherapy group.Kaplan-Meier curves were plotted and log-rank test was done to compare the overall survival time and progressio-free
作者
付靖
王韬
赵亚
刘钰蛟
李耀南
仝玉阳
仓顺东
FU Jing;WANG Tao;ZHAO Ya;LIU Yujiao;LI Yaonan;TONG Yuyang;CANG Shundong(Department of Oncology,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Emergency,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2023年第10期993-998,共6页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省省部共建重点项目(SBGJ202002011)
河南省科技攻关计划项目(212102310163)
中国临床肿瘤协会(CSCO)-豪森肿瘤研究基金资助项目(Y-HS202102-0076)
北京科创医学发展基金(KC2021-JX-0186-47)。
关键词
非小细胞肺癌
EGFR-TP53共突变
靶向同步化疗
靶向序贯化疗
non-small-cell lung cancer
EGFR-TP53 co-mutation
EGFR-TKI combined with concurrent chemotherapy
EGFR-TKI combined with sequential chemotherapy
