EGFR突变状态对Ⅲ期非鳞非小细胞肺癌患者放化疗近期疗效和长期生存的预测价值

摘要

背景与目的,表皮生长因子受体(epidermal growth factor receptor,EGFR)突变状态与Ⅲ期非小细胞肺癌放化疗近期疗效和生存的关系是目前临床研究热点.本研究旨在探讨EGFR突变状态与Ⅲ期非鳞非小细胞肺癌放化疗疗效的关系.方法,本研究共计人组187例Ⅲ期非鳞非小细胞肺癌患者,其中87例能够评估放化疗近期疗效和2年生存率,128例患者适合评估一线化疗疗效.采用变性高效液相色谱法检测EGFR基因突变状态.结果,EGFR突变阳性患者对联合放化疗的客观缓解率为84.6%(33/39),明显高于EGFR突变阴性患者56.3%(27/48)(P=0.004).2年生存率EGFR突变阳性患者为53.8%(21/39),EGFR突变阴性患者为50%(24/48),两组在长期生存方面无统计学差异(P=0.871).结论,在Ⅲ期非鳞非小细胞肺癌中,EGFR突变预示更高的放化疗近期疗效,与生存期无关.%Background and objective The presence of epidermal growth factor receptor (EGFR) mutations is predictive of a better response to EGFR tyrosine kinase inhibitors (EGFR-TKIs) and initial chemotherapy in advanced non-squamous non-small cell lung cancer (NSCLC). The aim of this study is to analyze the association between the EGFR mutations and the outcome of combined chemoradiotherapy in stage III non-squamous NSCLC. Methods Patients with stage III non-squamous NSCLC whose EGFR mutation status had been identified were retrospectively analyzed. The response of 87 patients to combined chemoradiotherapy; the two-year survival rate, and the response of 128 patients to initial chemotherapy were evaluated. Results The response rate to combined chemoradiotherapy was 84.6% (33/39) in EGFR mutation-positive patients, significantly higher than the 56.3% (27/48) response rate in EGFR mutation-negative patients (P=0.004). Two-year survival rates were 53.8% and 50% in EGFR mutation-positive and mutation-negative patients, respectively. There was no significant difference in the overall survival for both patient groups. The overall response rate to initial chemotherapy was 34.5% (19/55) in EGFR mutation-positive patients^ compared with the 21.9% (16/73) response rate in EGFR mutation-negative patients. Conclusion EGFR mutation-positive status can predict better response to combined chemoradiotherapy; but is not associated with overall survival in patients with stage III non-squamous NSCLC.