背景与目的 表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinases inhibitors,EGFR-TKIs)普遍应用后,其治疗失败后预后情况引起学界的关注.本研究旨在回顾性分析Ⅳ期肺腺癌患者的临床资料,探讨EGFR-TKIs治疗失败后影响预后的相关因素.方法 收集2009年1月-2012年2月体能状态评分(performance status,PS)为0分-2分的Ⅳ期肺腺癌患者,随访至死亡.主要观察指标为EGFR-TKIs治疗失败后的生存时间(overall survival,OS).结果 共81例患者入组,中位OS为9.6个月(QL-QU:5.4-19.2).单因素分析显示,PS评分、多部位的转移及靶向药物治疗后出现中/大量胸水对预后有影响(P＜0.05),靶向治疗失败后血CEA水平正常及曾有手术史也表明患者更能得到生存时间获益的趋势.多因素分析显示,PS评分、多部位转移及靶向药物治疗后出现中/大量胸水可以作为Ⅳ期肺腺癌患者独立的预后因素(P＜0.05).结论晚期肺腺癌PS评分为0分-1分、单脏器的转移及靶向药物治疗后出现无或少量胸水可获得较好的生存时间,应采取积极的化学药物治疗.%Background and objective The prognostic factors and salvage therapy after the failure of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) therapy have brought concerns. This study aims to analyze retrospectively the clinical data of patients with advanced lung adenocarcinoma and explore their prognostic factors. Methods Patients with integral clinic dates and staged IV lung adenocarcinoma with performance status (PS) scores from 0 to 2 were enrolled between January 2009 and February 2012 and followed up until death. The primary endpoint was survival time after the failure of EGFR-TKI therapy. Results A total of 81 patients were enrolled into the study, and the median overall survival time was 9.6 months (Qi-Qu: 5.4-19.2). Univariate analysis showed that PS score, metastatic status, and the presence of plural effusion were significantly correlated with patient survival time (P<0.05), whereas normal levels of carcinoembryonic antigen after EGFR-TKI therapy and history of operation showed a trend towards longer survival time. Multivariate analysis showed that the PS score, metastatic status, and plural effusion are independent prognostic factors for advanced adenocarcinoma after the failure of targeted therapy (P<0.05). Conclusion A PS score from 0 to 1, single metastasis, and none or less plural effusion may attribute to the good outcome of stage Ⅳ lung adenocarcinoma and should further undergo chemotherapy.
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