[1]郑林鹏,许子寒,朱广阔,等.临床参数对Ⅳ期非小细胞肺癌一线EGFR-TKIs疗效的预测价值[J].第三军医大学学报,2019,41(04):346-352.
 ZHENG Linpeng,XU Zihan,ZHU Guangkuo,et al.Predictive value of clinical parameters in responses to epidermal growth factor-tyrosine kinase inhibitors as first-line therapy for stage Ⅳ non-small cell lung cancer[J].J Third Mil Med Univ,2019,41(04):346-352.
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临床参数对Ⅳ期非小细胞肺癌一线EGFR-TKIs疗效的预测价值(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第04期
页码:
346-352
栏目:
临床医学
出版日期:
2019-02-28

文章信息/Info

Title:
Predictive value of clinical parameters in responses to epidermal growth factor-tyrosine kinase inhibitors as first-line therapy for stage Ⅳ non-small cell lung cancer
作者:
郑林鹏许子寒朱广阔李奉杨峤余永新孙建国
陆军军医大学(第三军医大学)第二附属医院全军肿瘤研究所
Author(s):
ZHENG Linpeng XU Zihan ZHU Guangkuo LI Feng YANG Qiao YU Yongxin SUN Jianguo  

Cancer Institute, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

关键词:
非小细胞肺癌表皮生长因子受体酪氨酸激酶抑制剂临床参数肿瘤标志物预后
Keywords:
non-small cell lung cancer epidermal growth factorreceptor-tyrosine kinase inhibitors clinical parameter tumor biomarker prognosis  
分类号:
R734.2; R969.4; R979.1
文献标志码:
A
摘要:

目的 通过分析临床参数与表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factorreceptor-tyrosine kinase inhibitors, EGFR-TKIs)疗效的关系,为一线Ⅳ期非小细胞肺癌(non-small cell lung cancer,NSCLC)EGFR-TKIs治疗疗效寻找简易的标志物。方法 回顾性分析2010-2016年在本院接受一线EGFR-TKIs (厄洛替尼、吉非替尼、埃克替尼) 治疗的Ⅳ期EGFR阳性突变NSCLC患者的临床参数与疗效的关系。结果 共纳入123例,其中男性43例,女性80例,年龄28~84岁,客观缓解率(objective response rate,ORR)47.97%,疾病控制率(disease control rate,DCR)100%,中位无进展生存期(median progression-free survival,mPFS)11.0个月,中位总生存期 (median overall survival,mOS) 22.7个月。单因素分析显示治疗前低NSE、CA125或Cyfra21-1者PFS较长(14.2 vs 9.1个月,P<0.001;12.4 vs 9.5个月,P=0.024;12.3 vs 9.5个月,P=0.033)。而PS评分0~1分,低NSE、CA125、Cyfra21-1或CA15-3者OS较长(mOS:24.0 vs 16.5个月,P=0.001;27.7 vs 17.3个月,P<0.001;25.4 vs 20.2个月,P=0.002;25.7 vs 18.1个月,P=0.027;25.5 vs 18.7个月,P=0.009)。多因素分析结果显示CA125和NSE是PFS的独立影响因素,而CA125、NSE、CA15-3、肝转移、PS评分是OS的独立影响因素。CA125、Cyfra21-1、CA15-3和NSE 4个参数中多个参数升高的PFS、OS较单个参数升高短 (mPFS:9.3 vs 11.8个月,P=0.045;mOS:18.7 vs 27.4个月,P=0.001)。结论 治疗前低水平的CA125或NSE预示着Ⅳ期NSCLC一线EGFR-TKIs治疗的PFS较长,而PS评分0~1分,低水平的NSE、CA125或CA15-3则预示OS较长。CA125、Cyfra21-1、CA15-3和NSE 4个临床参数联合有望成为预测Ⅳ期NSCLC一线EGFR-TKIs疗效的简易标志物。

Abstract:

Objective To analyze the relationship between the clinical parameters and the efficacy of epidermal growth factorreceptor-tyrosine kinase inhibitors (EGFR-TKIs) as the first-line therapy in patients with stage Ⅳ non-small cell lung cancer (NSCLC) and identify the clinical markers for predicting the patients’ responses to the treatment. Methods The clinical data were retrospectively reviewed for the patients with stage Ⅳ EGFR mutation-positive NSCLC receiving EGFR-TKIs (erlotinib, gefitinib, and icotinib) as the first-line therapy in our hospital between January, 2010 and December, 2016, and the relationship between the patients’ clinical parameters and responses to the treatment were analyzed. Results A total of 123 patients (43 males and 80 females, aged ranging from 28 to 84 years) were included in this study. The objective response rate (ORR) of the overall patients was 47.97%, the disease control rate (DCR) was 100%, the median progression-free survival (mPFS) time was 11.0 months, and the median overall survival (OS) time was 22.7 months. Univariate analysis showed that the patients with low levels of neuronspecific enolase (NSE), carbohydrate antigen 125 (CA125) or Cyfra21-1 before the treatment had significantly prolonged mPFS time (NES: 14.2 vs 9.1 months, P<0.001; CA125: 12.4 vs 9.5 months, P=0.024; Cyfra21-1: 12.3 vs 9.5 months, P=0.033); the mOS time was significantly prolonged in patients with ECOG performance status of 0~1 (24.0 vs 16.5 months, P=0.001) and low levels of NSE (27.7 vs 17.3 months, P<0.001), CA125 (25.4 vs 20.2 months, P=0.002), Cyfra21-1 (25.7 vs 18.1 months, P=0.027) or CA15-3 (25.5 vs 18.7 months, P=0.009). Multivariate analysis suggested that CA125 and NSE were independent prognostic factors of PFS, and CA125, NSE, CA15-3, hepatic metastasis and performance status were independent prognostic factors of the OS time. Combined analysis of CA125, Cyfra21-1, CA15-3 and NSE showed that compared with those with elevation of a single factor, the patients with elevation of multiple factors had shorter mPFS time (9.3 vs 11.8 months, P=0.045) and also shorter mOS time (18.7 vs 27.4 months, P=0.001). ConclusionLow levels of CA125 or NSE before first-line EGFR-TKIs treatment are associated with longer PFS time of the patients with stage Ⅳ NSCLC, while performance status of 0~1 and low levels of NSE, CA125 or CA15-3 are associated with a longer OS time of the patients. The combination of CA125, Cyfra21-1, CA15-3 and NSE is expected to serve as a simple indicator for predicting the efficacy of firstreceptor-line EGFR-TKIs therapy in patients with stage Ⅳ NSCLC.

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更新日期/Last Update: 2019-02-22