2023 年第 2 期 第 18 卷

晚期非小细胞肺癌患者表皮生长因子受体基因突变的危险因素及表皮生长因子受体酪氨酸激酶抑制剂的疗效分析

Risk factors of epidermal growth factor receptor gene mutation in patients with non-small cell lung cancer and the effect of epidermal growth factor receptor-tyrosine kinase inhibitor

作者：姬巧霞张红斌王愿赵敏

英文作者：Ji Qiaoxia Zhang Hongbin Wang Yuan Zhao Min

单位：河北省胸科医院肿瘤二科，石家庄050041

英文单位：Second Department of Oncology Hebei Chest Hospital Shijiazhuang 050041 China

关键词：非小细胞肺癌；表皮生长因子受体；基因突变；靶向治疗

英文关键词：Non-smallcelllungcancer;Epidermalgrowthfactorreceptor;Genemutation;Targetedtherapy

• 摘要：

• 目的 探讨晚期非小细胞肺癌（NSCLC）患者表皮生长因子受体（EGFR）基因突变的危险因素及EGFR酪氨酸激酶抑制剂（TKI）的疗效。方法 回顾性选取河北省胸科医院2018年5月至2021年1月收治的150例晚期NSCLC患者，包括EGFR基因突变58例、野生型92例。EGFR基因突变患者根据自愿原则接受EGFR-TKI（39例）或含铂化疗方案（19例）治疗。分析晚期NSCLC患者EGFR基因突变的危险因素，比较不同治疗方案患者的客观缓解率（ORR）、疾病控制率（DCR）。随访1年，统计EGFR基因突变患者无进展生存期及1年无进展生存率。结果 58例EGFR基因突变晚期NSCLC患者中，以EGFR基因外显子19（24例）、21（17例）突变最为常见。EGFR基因突变发生率在不同性别、病理类型和有无吸烟史的患者中比较，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果表明，女性（比值比=2.530,95%置信区间：1.176~5.443，P=0.018）、腺癌（比值比=3.401,95%置信区间：1.449~7.980，P=0.005）、无吸烟史（比值比=2.478，95%置信区间：1.105~5.556，P=0.031）是NSCLC患者EGFR基因突变的独立危险因素。EGFR-TKI治疗患者的ORR、DCR均高于化疗患者（均P＜0.05）。EGFR-TKI治疗患者中，女性患者ORR高于男性患者，腺癌、无吸烟史患者的ORR、DCR分别高于非腺癌、有吸烟史患者（均P＜0.05）。EGFR-TKI治疗患者1年无进展生存率高于化疗患者（P＜0.001）。在EGFR-TKI治疗患者中，女性、腺癌、无吸烟史患者1年无进展生存率分别高于男性、非腺癌、有吸烟史患者（均P＜0.05）。结论 EGFR-TKI治疗EGFR基因突变晚期NSCLC患者的临床效果及短期预后优于含铂方案化疗。女性、腺癌、无吸烟史是EGFR基因突变的危险因素，且此类患者接受EGFR-TKI治疗后获益更加明显。

• Objective To explore risk factors of epidermal growth factor receptor (EGFR) gene mutation in patients with non-small cell lung cancer (NSCLC) and the effect of EGFR-tyrosine kinase inhibitor (TKI). Methods  Totally 150 patients with advanced NSCLC were retrospectively enrolled in Hebei Chest Hospital from May 2018 and January 2021, including 58 cases with EGFR gene mutation and 92 cases with wild type of EGFR. According to the principle of voluntariness, patients with EGFR gene mutation were treated with EGFR-TKI (39 cases) or platinum-based chemotherapy regimen (19 cases). Risk factors of EGFR gene mutation were analyzed in patients with NSCLC. The objective response rate (ORR) and disease control rate (DCR) were compared between patients with different treatment. Patients with EGFR gene mutation were followed-up for 1 year, and progression-free survival (PFS) and 1-year progression-free rate were counted. Results  Among 58 cases with EGFR gene mutation, the most common mutation sites were 19 exon (24 cases) and 21 exon (17 cases). There was significant difference in EGFR gene mutation rate in patients with different gender, pathological types and smoking history respectively (all P<0.05). Multivariate Logistic regression analysis showed that female ［odds ratio (OR)=2.530, 95% confidence interval (CI):1.176-5.443,P=0.018］, adenocarcinoma (OR=3.401, 95%CI:1.449-7.980, P=0.005) and never smoking (OR=2.478,95%CI:1.105-5.556, P=0.031) were independent risk factors of EGFR gene mutation in NSCLC patients. ORR and DCR in patients with EGFR-TKI were higher than those in patients with chemotherapy (both P<0.05). Among patients with EGFR-TKI, ORR in female was higer than that in male, ORR and DCR in patients with adenocarcinoma and never somking were higher than those in patients with non-adenocarcinoma and somking history respectively (all P<0.05). The 1-year progression-free rate in patients with EGFR-TKI was higher than that in patients with chemotherapy (P<0.001). Among patients with EGFR-TKI, the 1-year progression-free rates in female, adenocarcinoma and never somking patients were higher than those in male, non-adenocarcinoma and smoking history patients (all P<0.05). Conclusions  In patients with advanced NSCLC with EGFR gene mutation, clinical effect and short-term prognosis of EGFR-TKI are better than those of platinum-based chemotherapy. Female, adenocarcinoma and never smoking are risk factors of EGFR gene mutation, and the improvement effect of EGFR-TKI therapy is more significant in such patients.