摘要
目的探讨治疗前血清癌胚抗原（CEA）对表皮生长因子受体（EGFR）突变的晚期肺腺癌患者接受酪氨酸激酶抑制剂（TKIs）治疗疗效及生存的影响。方法回顾性分析首都医科大学附属北京胸科医院肿瘤内科2005年12月至2013年4月接受吉非替尼、厄洛替尼或盐酸埃克替尼治疗的120例EGFR突变晚期肺腺癌患者的临床资料,评价TKIs治疗疗效并分析影响患者预后的因素。根据实体瘤疗效评价标准1.1版（RECIST 1.1）评价近期疗效,Kaplan-Meier法进行生存分析,Cox风险比例模型分析影响预后的因素。结果全组患者接受EGFR-TKIs治疗的有效率（RR）为57.5%,疾病控制率（DCR）为94.2%。全组患者的中位无进展生存期（PFS）为9.0个月（95%CI：7.91~10.09个月）,中位生存时间（OS）为23.5个月（95%CI：17.89~29.11个月）。治疗前血清CEA≥5 ng/ml者（n=53）和CEA〈5 ng/ml者（n=67）的RR分别为60.4%、55.2%（P〉0.05）;两组患者的中位PFS分别为8.0个月、10.0个月（P〉0.05）,中位OS分别为17.2个月、30.0个月（P=0.022）。Cox多因素分析显示,吸烟状况、血清CEA水平及PS评分是影响肺腺癌OS的独立因素。结论 EGFR突变的肺腺癌患者中,治疗前血清CEA水平不影响TKIs治疗的疗效,但CEA〈5 ng/ml者的预后更好,尚有待前瞻性研究进一步证实。
Objective To investigate the effects of pre-treatment serum carcinoembryonic antigen（CEA）on the efficacy and sur-vival of tyrosine kinase inhibitors（TKIs） in the EGFR-mutant patients with advanced lung adenocarcinoma.Methods The clinical dataof 120 patients with EGFR mutant advanced lung adenocarcinoma treated with gefitinib, erlotinib or icotinib hydrochloride at our depart-ment between December 2005 and April 2013 were retrospectively reviewed, and influencing factors of response and survival were ana-lyzed. Differences in efficacy between variables were evaluated using the Response Evaluation Criteria in Solid Tumors（RECIST）（version1. 1）. Progression free survival（PFS）and overall survival（OS） were estimated by the Kaplan-Meier method. Independent risk factors wereassessed in multivariate analysis using the Cox proportional hazards model.Results The response rate（RR） and disease control rate（DCR） were 57. 5% and 94. 2%, respectively, the median PFS was 9. 0 months（95%CI：7. 91-10. 09 months） and median OS was 23. 5 months（95%CI：17. 89-29. 11 months）. The pre-treatment serum CEA level was positive（≥5 ng/ ml） for 44. 2% of the patients. Neitherthe RR to TKIs（55. 2%vs.60. 4%,P= 0. 5721） nor PFS（10. 0 monthsvs.8. 0 months,P〉0. 05） had significant differences betweenthe two groups of CEA〈5 ng/ ml and CEA≥5 ng/ ml. The median OS of patients with CEA〈5 ng/ ml was significantly better（30. 0 monthsvs.17. 2 months,P= 0. 022）. A multivariate analysis indicated smoking, serum CEA and PS performance scoring to be independent prog-nostic factors.Conclusion It shows that the serum CEA〈5 ng/ ml may not be a predictive factor for the efficacy of EGFR-TKIs, but it isa positive prognostic factor for EGFR mutant advanced lung adenocarcinoma patients undergoing this treatment.
出处
《临床肿瘤学杂志》
CAS
2015年第2期116-121,共6页
Chinese Clinical Oncology
