摘要
目的 探讨安罗替尼联合靶向后线治疗晚期经治的基因突变阳性肺腺癌的疗效、安全性以及对凝血指标及C-反应蛋白的影响。方法 回顾性分析2019年12月31日至2023年12月31日安徽省胸科医院晚期经治肺腺癌患者59例,为经二线或二线以上治疗疾病进展的患者,基因检测提示敏感突变,其中31例行安罗替尼联合靶向治疗(观察组),同期收治的28例患者仅行单靶向治疗(对照组);观察分析比较两组患者的临床疗效、不良反应发生率、凝血指标及C-反应蛋白的变化;采用Kaplan-Meier生存分析方法统计分析无进展生存期(PFS)和总生存期(OS),通过Cox多因素回归分析确定预后影响因素。结果 观察组的客观缓解率(ORR)、疾病控制率(DCR)分别为35.5%、93.5%,均高于对照组(7.1%、89.3%);中位PFS和OS分别为9个月和22个月,均优于对照组中位PFS 6.5个月和中位OS 12.5个月,差异有统计学意义(P均<0.05);两组均未出现3级及以上的不良反应,观察组仅5例出现安罗替尼相关药物不良反应,1例减量处理(手足综合征),余4例(1例高血压、3例甲状腺功能异常)均未行临床干预。两组治疗后凝血指标纤维蛋白原(Fib)及C-反应蛋白(CRP)比较差异有统计学意义(P均<0.001);观察组治疗后凝血指标中血小板计数(PLT)和D-二聚体降低(D-D),Fib升高,与治疗前相比差异有统计学意义(P均<0.05)。C-反应蛋白治疗后较治疗前降低,差异有统计学意义(P=0.030)。脑转移和C-反应蛋白≥10mg/L为两组患者OS的独立危险因素,一线靶向联合化疗、后线联合安罗替尼治疗为OS的保护因素。结论 安罗替尼联合靶向治疗可显著改善经治的携带敏感基因突变的晚期肺腺癌的预后,初步确定了炎症指标C-反应蛋白及是否存在脑转移是影响此类患者OS的潜在因素。治疗过程会引起凝血指标的变化,但并未发生相关血栓性不良事件,安全性可控。
Objective To investigate the efficacy and safety of anlotinib combined with targeted therapy for advanced,previously treated,gene-mutated positive lung adenocarcinoma,and its effect on coagulation indicators and C-reactive protein.Methods The clinical data of 59 advanced lung adenocarcinoma patients were retrospectively analyzed,who underwent second-line or above treatment,and genetic testing suggested sensitive mutations in the Anhui Chest Hospital from December 31,2019 to December 31,2023.Among these,31 underwent treatment with anlotinib combined with targeted therapy(the observation group),and another 28 patients were only treated with targeted therapy during the same period(the control group).Their clinical efficiency,incidence of adverse reactions,coagulation indicators,and variations in C-reactive protein were compared between the two groups.Kaplan-Meier survival analysis facilitated the statistical investigation of progression-free survival(PFS)and overall survival(OS),while Cox multivariate regression analysis assisted in identifying prognostic indicators.Results The objective response rate(ORR)and disease control rate(DCR)of the observation group were 35.5%and 93.5%,respectively,both higher than those in the control group(7.1%and 89.3%).Median progression-free survival(PFS)and overall survival(OS)in the observation group were 9 months and 22 months respectively,faring better than those in the control group(PFS:6.5 months,OS:12.5 months)(P<0.05).There was no the adverse reactions of Grade 3 or above occurred in both group. Within the observation group, 5 cases of anlotinib-related adverse reactions were reported, where one required a dose reduction due to hand-foot syndrome. No clinical intervention was necessary for the remaining four cases (1 hypertension, 3 thyroid dysfunction). There was a statistically significant difference in coagulation indicators, fibrinogen (Fib) and C-reactive protein (CRP), post-treatment between the two groups ( P <0.001). In the observation group, post-treatment showed decre
作者
陈文俊
汪睿
CHEN Wenjun;WANG Rui(Department of Oncology,Anhui Chest Hospital,Hefei,Anhui 230022,China)
出处
《临床肺科杂志》
2024年第8期1213-1220,共8页
Journal of Clinical Pulmonary Medicine
基金
安徽医科大学临床与前期学科共建项目(No.2022017)。
关键词
安罗替尼
靶向治疗
肺腺癌
凝血指标
C-反应蛋白
anlotinib
targeted therapy
lung adenocarcinoma
coagulation indicator
C-reactive protein
