常见EGFR突变基因型对晚期肺腺癌二线治疗策略的影响

发布时间：2018-02-28 00:51

本文关键词： 表皮生长因子受体基因型 19外显子缺失突变 21外显子L858R突变生存分析　出处：《昆明医科大学》2016年博士论文　论文类型：学位论文

【摘要】：目的：研究常见的表皮生长因子受体突变基因型(19外显子缺失突变与21外显子L858R替代突变)对于晚期肺腺癌患者二线治疗(二线靶向治疗与二线化疗)的影响。方法：收集昆明医科大学第一附属医院及昆明医科大学第三附属医院自2010年4月1日至2012年12月31日肺腺癌患者的临床资料,其中包含一线化疗进展后二线靶向治疗患者128例及一线靶向治疗进展后二线化疗患者94例。收集的资料包括姓名、性别、年龄、ECOG评分、临床分期、吸烟状态、影像大体肿瘤类型、使用的表皮生长因子受体络氨酸激酶抑制剂药物类型及表皮生长因子受体突变亚型。入选病例需根据入选及排除标准进行选择,入选标准包括：IIIb期或IV期肺腺癌;EGFR突变;年龄18-80岁,二线靶向治疗组至少接受1周期化疗;二线化疗组需一线靶向治疗进展；ECOG评分0-2分；预期生存大于3月；有可供评估的病灶。然后,对所有入选病例进行电话随访,并通过PACS系统回顾入选患者CT/MRI等影像资料以获得患者生存信息及疗效信息,所获得资料信息输入SPSS 19.0进行统计学分析。结果：经一线化疗进展的晚期肺腺癌患者接受二线表皮生长因子受体络氨酸激酶抑制剂靶向治疗时,19外显子缺失突变较21外显子L858R替代突变患者的无进展生存期及总生存期更长(Median PFS:8.1 Vs 6.8 months, P=0.002; Median OS:17.6 Vs 12.5 months, P=0.000)。而经一线靶向治疗进展的晚期肺腺癌患者行二线化疗时,19外显子缺失突变患者与21外显子替代突变患者两组人群的无进展生存期及总生存期类似：总生存期(Median 8.2 Vs.8.6月,P=0.865)及无进展生存期(Median 4.1 Vs.4.2月,P=0.837)。结论：经一线化疗进展的晚期肺腺癌患者接受二线表皮生长因子受体络氨酸激酶抑制剂靶向治疗时,19外显子缺失突变较21外显子L858R替代突变具有更好的生存；而经一线靶向治疗进展的晚期肺腺癌患者行二线化疗时,19外显子缺失突变患者与21外显子替代突变患者两组人群的生存结果相似。
[Abstract]:Aim: to study the effect of deletion mutation of exon 19 and L858R substitution mutation of EGF receptor mutation genotype on second-line therapy (second-line targeting therapy and second-line chemotherapy) in patients with advanced lung adenocarcinoma. Methods: the clinical data of patients with lung adenocarcinoma were collected from the first affiliated Hospital of Kunming Medical University and the third affiliated Hospital of Kunming Medical University from April 1st 2010 to December 31st 2012. The data included 128 cases of second-line targeted therapy after the progression of first-line chemotherapy and 94 cases of second-line chemotherapy after first-line targeted therapy. The data collected included name, sex, age and ECOG score, clinical stage, smoking status. The type of tumor, the drug type of epidermal growth factor receptor complex aminokinase inhibitor and the mutant subtype of epidermal growth factor receptor were selected according to the selection and exclusion criteria. The inclusion criteria included EGFR mutation in lung adenocarcinoma in stage II IIIb or IV; age 18-80 years old and the second line targeted therapy group received at least one cycle of chemotherapy; the second line chemotherapy group required a score of 0-2 points in the progress of first-line targeted therapy and ECOG score; the expected survival was greater than March; Then, all the patients were followed up by telephone, and the patients' CT/MRI and other imaging data were reviewed by PACS system to obtain the information of survival and curative effect. The obtained data were inputted into SPSS 19.0 for statistical analysis. Results: the exon deletion mutation of exon 19 in advanced lung adenocarcinoma patients undergoing first-line chemotherapeutic progress was detected after targeted therapy with 2-line epidermal growth factor receptor complex aminokinase inhibitor. The progressive survival time and total survival time of patients with L858R substitution mutation at exon 21 were longer than those of patients with median PFS:8.1 Vs 6.8 months, P0. 002; Median OS:17.6 Vs 12.5 months, P0. 0000.The deletion mutation of exon 19 was found in advanced lung adenocarcinoma patients with advanced lung adenocarcinoma treated by first-line targeted therapy. The progression-free survival and total survival of patients with exon 21 exon replacement mutation were similar: total survival time (mean 8.2 Vs.8.6 / month) and progressive survival time (Median 4.1 Vs.4.2 / month P0. 837). Conclusion: advanced lung adenocarcinoma developed by first-line chemotherapy is associated with advanced lung adenocarcinoma. The deletion mutation of exon 19 was better than that of L858R substitution mutation in exon 21 after targeted therapy with 2-line epidermal growth factor receptor complex aminokinase inhibitor. The survival results of patients with exon deletion mutation of exon 19 and patients with substitution mutation of exon 21 were similar to those of patients with advanced lung adenocarcinoma undergoing second-line chemotherapy.
【学位授予单位】：昆明医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R734.2

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