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奥希替尼治疗EGFR基因敏感突变晚期肺腺癌的疗效及脑转移的影响因素分析
作者:张静1  赵天1  丁亚楠1  赵晓飞2 
单位:1. 邢台市第三医院 药剂科, 河北 邢台 054000;
2. 邢台医学高等专科学校第二附属医院 临床药学科, 河北 邢台 054000
关键词:奥希替尼 EGFR基因 肺腺癌 脑转移 
分类号:R734.2
出版年·卷·期(页码):2021·49·第三期(273-279)
摘要:

目的:探讨奥希替尼治疗EGFR基因敏感突变晚期肺腺癌的疗效及其预防脑转移的作用机制。方法:回顾性选取邢台市第三医院于2017年1月至2019年1月收治的68例EGFR基因敏感突变晚期肺腺癌患者为研究对象,根据治疗方法将患者分成两组,分别为奥希替尼组(42例)和吉非替尼组(26例)。比较两组患者临床疗效、脑转移率,肿瘤标志物[细胞角蛋白19片段(CYFRA21-1)、糖类抗原125(CA125)、血管内皮生长因子(VEGF)]水平以及四跨膜蛋白CD151表达水平、不良反应以及生存情况。另根据患者治疗期间是否发生脑转移分为脑转移组和未脑转移组,比较两组患者CD151表达水平,并采用Cox模型进行生存预后多因素分析。结果:奥希替尼组客观有效率(ORR)、疾病控制率(DCR)明显高于吉非替尼组(P<0.05)。治疗后,奥希替尼组患者肿瘤标志物和CD151水平显著低于吉非替尼组(P<0.05)。奥希替尼组患者中位生存时间[(11.06±0.32)月]长于吉非替尼组患者中位生存时间[(9.09±0.21)月](log-rank P=0.024)。TNM分期、发生脑转移、吸烟是影响EGFR基因敏感突变晚期肺腺癌患者预后的独立危险因素。奥希替尼组新发脑转移率(21.62%)显著低于吉非替尼组(45.83%)(P<0.05),脑转移组CD151表达水平显著高于未脑转移组(P<0.05)。结论:奥希替尼治疗EGFR基因敏感突变晚期肺腺癌临床疗效显著,其作用机制可能是通过CD151调控相关通路蛋白表达,从而影响肺癌细胞增殖和迁移过程,延长患者生存期。

Objective: To investigate the efficacy of osimertinib in the treatment ofadvanced lung adenocarcinoma with sensitive mutation of EGFR gene and analysis of the factors affectingbrain metastasis. Methods: Retrospectively selected 68 cases of advanced lung adenocarcinoma patients with sensitive mutation ofEGFR gene who were admitted to the Third Hospital of Xingtai City from January 2017 to January 2019 as the research objects. According to different treatment method, they were divided into the osimertinib group(42 cases) and the gefitinib group(26 cases). The clinical efficacy, brain metastasis rate, the levels of tumor markers[cytokeratin 19 fragment (CYFRA21-1), carbohydrate antigen 125 (CA125), vascular endothelial growth factor (VEGF)]and four transmembrane protein CD151 were compared between the two groups. In addition, patients were divided into brain metastasis group and non-brain metastasis group according to whether the patients had brain metastasis during treatment. The CD151 expression levels of the two groups were compared, and the Cox model was used for multi-factor analysis of survival and prognosis. Results: The objective response rateand disease control rate in the osimertinib group were significantly higher than those in the gefitinib group (P<0.05). After treatment, the levels of tumor markers and CD151 in the osimertinib group were significantly lower than those in the gefitinib group (P<0.05). The median survival time of patients in the osimertinib group[(11.06±0.32) months] was longer than that of gefitinib[(9.09±0.21) months] (log-rank P=0.024). TNM stage, brain metastasis, and smoking were independent risk factors which affected the prognosis of advanced lung adenocarcinomapatients with sensitive mutation of EGFR gene. The rate of new brain metastasis (21.62%) in the oxitinib group was significantly lower than that in the gefitinib group (45.83%) (P<0.05), and the expression level of CD151 in the brain metastasis group was significantly higher than that in the non-brain metastasis group (P<0.05). Conclusion: Osimertinib has significant clinical efficacy in the treatment ofadvanced lung adenocarcinoma with EGFR gene-sensitive mutations. The mechanism of action may be throughCD151 regulatingthe expression of related pathwwayproteins, thereby affecting the proliferation and migration of lung cancer cells and prolonging the survival of patients. period.

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