非小细胞肺癌患者EGFR-TKIs耐药后射频消融治疗的疗效及预后分析
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摘要
目的探究射频消融术治疗EGFR-TKIs耐药的非小细胞肺癌患者的疗效及对预后的影响。方法选择2012年6月至2016年6月我院救治的105例非小细胞肺癌患者作为研究对象,最终将符合实验设计的88例非小细胞肺癌患者纳入本次研究。根据EGFR-TKIs耐药后治疗方式不同,将88例非小细胞肺癌患者分为2组,即射频消融组(46例)和化疗组(42例)。比较两组患者治疗后客观有效率、不良反应和并发症发生率。随访3年,比较两组患者生存率,并对影响患者预后的因素进行生存分析。结果射频消融组和化疗组患者患者治疗后客观有效率分别为95.65%(44/46)和78.57%(33/42),差异有统计学意义(P<0.05)。15例(32.61%)患者射频消融治疗后出现咯血,5例(10.87%)发生胸痛,7例(15.22%)气紧,6例(13.04%)发生气胸。37例(88.10%)患者化疗后出现骨髓抑制,43例(100.00%)患者化疗后均有不同程度消化道反应。射频消融组患者1a、2a、3a无瘤生存率分别为47.83%(22/46)、30.43%(14/46)和17.39%(8/46);化疗组患者1a、2a、3a无瘤生存率分别为35.71%(15/42)、16.67%(7/42)和4.76%(2/42)。两组患者1a、2a、3a无瘤生存率比较,差异不具统计学意义(P>0.05)。射频消融组患者1a、2a、3a总生存率分别为67.39%(31/46)、36.96%(17/46)和17.39%(8/46);化疗组患者1a、2a、3a无瘤生存率分别为64.29%(27/42)、33.33%(14/42)和9.52%(4/42)。两组患者1a、2a、3a总生存率比较,差异不具统计学意义(P>0.05)。单因素分析结果显示TNM分期、淋巴结转移、ECOG评分和肿瘤直径与非小细胞肺癌患者无瘤生存时间和总生存时间均有关。多因素Cox回归分析结果显示TNM分期、淋巴结转移和ECOG评分是非小细胞肺癌患者无瘤生存时间的独立危险因素;TNM分期、淋巴结转移、ECOG评分和肿瘤直径是非小细胞肺癌患者总生存时间的独立危险因素。结论射频消融可抑制非小细胞肺癌患者EGFR-TKIs耐药后肿瘤局部进展,提高无瘤生存时间和总生存时间。
Objective To investigate the efficacy and prognosis of patients with non-small cell lung cancer treated with radio-frequency ablation for EGFR-TKIs resistant. Methods 105 patients with non-small cell lung cancer treated in our hospital from June 2012 to June 2016 were selected as the research subjects, and 88 cases of non small cell lung cancer patients were included in this study. According to the different treatment modalities after EGFR-TKIs resistance, 88 patients with non-small cell lung cancer were divided into 2 groups, the radio-frequency ablation group(46 cases) and the chemotherapy group(42 cases). Objective efficiency, adverse reactions and incidence of complications were compared between the two groups after treatment. During 3-year follow-up, their survival rates of the two groups were compared, and survival factors were analyzed. Results The objective effective rate of the radiofrequency ablation group and the chemotherapy group was 95.65%(44/46) and 78.57%(33/42) respectively(P<0.05). 15 cases(32.61%) had hemoptysis after radiofrequency ablation, 5 cases(10.87%) developed chest pain, 7 cases(15.22%) were tightened, 6 cases(13.04%) had pneumothorax, 37 patients(88.10%) developed myelosuppression after chemotherapy, and 43 patients(100%) had varying degrees of digestive tract reactions after chemotherapy. The tumor free survival rates of 1 a, 2 a and 3 a in the radio-frequency ablation group were 47.83%(22/46), 30.43%(14/46) and 17.39%(8/46), respectively. The tumor free survival rates of 1 a, 2 a and 3 a were 35. 71%( 15/42),16. 67%( 7/42) and 4. 76%( 2/42) in the chemotherapy group. There was no significant difference in the 1 a,2 a and 3 a tumor free survival rates between the two groups( P > 0. 05). The total survival rates of 1 a,2 a and 3 a in the radio-frequency ablation group were 67. 39%( 31/46),36. 96%( 17/46) and 17. 39%( 8/46),respectively. The survival rates of 1 a,2 a and 3 a were 64. 29%( 27/42),33. 33%( 14/42) and 9. 52%( 4/42) in the chemotherapy group. There was no significant difference in the overall survival rate of 1 a,2 a and 3 a between the two groups( P > 0. 05). Univariate analysis showed that TNM stage,lymph node metastasis,ECOG score,and tumor diameter were associated with tumor-free survival and overall survival in patients with non-small cell lung cancer. Multivariate Cox regression analysis showed that TNM staging,lymph node metastasis,and ECOG score were independent risk factors for tumor-free survival in patients with non-small cell lung cancer. TNM staging,lymph node metastasis,ECOG score,and tumor diameter were independent risk factors of overall survival in patients with non-small cell lung cancer. Conclusion Radio-frequency ablation can inhibit local tumor progression after EGFRTKIs resistance in patients with non-small cell lung cancer,and improve the tumor free survival time and overall survival time.
Objective To investigate the efficacy and prognosis of patients with non-small cell lung cancer treated with radio-frequency ablation for EGFR-TKIs resistant. Methods 105 patients with non-small cell lung cancer treated in our hospital from June 2012 to June 2016 were selected as the research subjects, and 88 cases of non small cell lung cancer patients were included in this study. According to the different treatment modalities after EGFR-TKIs resistance, 88 patients with non-small cell lung cancer were divided into 2 groups, the radio-frequency ablation group(46 cases) and the chemotherapy group(42 cases). Objective efficiency, adverse reactions and incidence of complications were compared between the two groups after treatment. During 3-year follow-up, their survival rates of the two groups were compared, and survival factors were analyzed. Results The objective effective rate of the radiofrequency ablation group and the chemotherapy group was 95.65%(44/46) and 78.57%(33/42) respectively(P<0.05). 15 cases(32.61%) had hemoptysis after radiofrequency ablation, 5 cases(10.87%) developed chest pain, 7 cases(15.22%) were tightened, 6 cases(13.04%) had pneumothorax, 37 patients(88.10%) developed myelosuppression after chemotherapy, and 43 patients(100%) had varying degrees of digestive tract reactions after chemotherapy. The tumor free survival rates of 1 a, 2 a and 3 a in the radio-frequency ablation group were 47.83%(22/46), 30.43%(14/46) and 17.39%(8/46), respectively. The tumor free survival rates of 1 a, 2 a and 3 a were 35. 71%( 15/42),16. 67%( 7/42) and 4. 76%( 2/42) in the chemotherapy group. There was no significant difference in the 1 a,2 a and 3 a tumor free survival rates between the two groups( P > 0. 05). The total survival rates of 1 a,2 a and 3 a in the radio-frequency ablation group were 67. 39%( 31/46),36. 96%( 17/46) and 17. 39%( 8/46),respectively. The survival rates of 1 a,2 a and 3 a were 64. 29%( 27/42),33. 33%( 14/42) and 9. 52%( 4/42) in the chemotherapy group. There was no significant difference in the overall survival rate of 1 a,2 a and 3 a between the two groups( P > 0. 05). Univariate analysis showed that TNM stage,lymph node metastasis,ECOG score,and tumor diameter were associated with tumor-free survival and overall survival in patients with non-small cell lung cancer. Multivariate Cox regression analysis showed that TNM staging,lymph node metastasis,and ECOG score were independent risk factors for tumor-free survival in patients with non-small cell lung cancer. TNM staging,lymph node metastasis,ECOG score,and tumor diameter were independent risk factors of overall survival in patients with non-small cell lung cancer. Conclusion Radio-frequency ablation can inhibit local tumor progression after EGFRTKIs resistance in patients with non-small cell lung cancer,and improve the tumor free survival time and overall survival time.
引文
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[10]柳菁菁,李双,李慧,等. EGFR-TKI联合化疗对比EGFR-TKI单药一线治疗EGFR敏感突变晚期非小细胞肺癌患者疗效的Meta分析[J].肿瘤,2018,38(4):362-370.
[11] ZHANG H,WANG J,ZHAO H Y,et al. Synthesis and biological evaluation of irreversible EGFR tyrosine kinase inhibitors containing pyrido[3,4-d]pyrimidine scaffold[J]. Bioorg Med Chem,2018,26(12):3619-3633.
[12] TAN C S,KUMARAKULASINGHE N B,HUANG Y Q,et al. Third generation EGFR TKIs:current data and future directions[J]. Mol Cancer,2018,17(1):29.
[13] WU S G,SHIH J Y. Management of acquired resistance to EGFR TKI-targeted therapy in advanced non-small cell lung cancer[J].Mol Cancer,2018,17(1):38.
[14]陈蕊,赵达,王丽娜.非小细胞肺癌EGFR-TKI耐药机制及治疗策略[J].肿瘤防治研究,2017,44(3):225-230.
[15]李光骁,陈晓明.射频消融与微波消融治疗肺肿瘤的对比研究[J].临床放射学杂志,2017,36(5):724-727.
[2] 佟娟.血清中趋化素在非小细胞肺癌中的表达和预后意义[J].临床肺科杂志,2018,23(3):417-420.
[3] MOUNTZIOS G.Making progress in epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer by surpassing resistance:third-generation EGFR tyrosine kinase inhibitors(EGFR-TKIs)[J].Ann Transl Med,2018,6(8):140.
[4] LIU S,CAO H,CHEN D,et al.LXR ligands induce apoptosis of EGFR-TKI-resistant human lung cancer cells in vitro by inhibiting Akt-NF-κB activation[J].Oncol Lett,2018,15(5):7168-7174.
[5] 宫艳美,韩福才.EGFR敏感突变肺腺癌患者EGFR-TKIs耐药后续治疗疗效分析[J].中国实用医药,2015,10(12):188-189.
[6] 刘宝东,李元博,胡牧,等.射频消融在EGFR-TKIs治疗非小细胞肺癌后局部进展的初步临床应用[J].中国肺癌杂志,2016,19(12):859-863.
[7] 王立红,付秀华,高俊珍,等.EGFR-TKIs治疗进展后停药与继续原药维持治疗晚期非小细胞肺癌的比较[J].肿瘤学杂志,2018,24(3):278-280.
[8] ZHANG S,ZHU L,XIA B,et al.Epidermal growth factor receptor (EGFR) T790M mutation identified in plasma indicates failure sites and predicts clinical prognosis in non-small cell lung cancer progression during first-generation tyrosine kinase inhibitor therapy:a prospective observational study[J].Cancer Commun(Lond),2018,38(1):28.
[9] FOGLI S,POLINI B,DEL RE M,et al.EGFR-TKIs in non-small-cell lung cancer:focus on clinical pharmacology and mechanisms of resistance[J]. Pharmacogenomics,2018,19(8):727-740.
[10]柳菁菁,李双,李慧,等. EGFR-TKI联合化疗对比EGFR-TKI单药一线治疗EGFR敏感突变晚期非小细胞肺癌患者疗效的Meta分析[J].肿瘤,2018,38(4):362-370.
[11] ZHANG H,WANG J,ZHAO H Y,et al. Synthesis and biological evaluation of irreversible EGFR tyrosine kinase inhibitors containing pyrido[3,4-d]pyrimidine scaffold[J]. Bioorg Med Chem,2018,26(12):3619-3633.
[12] TAN C S,KUMARAKULASINGHE N B,HUANG Y Q,et al. Third generation EGFR TKIs:current data and future directions[J]. Mol Cancer,2018,17(1):29.
[13] WU S G,SHIH J Y. Management of acquired resistance to EGFR TKI-targeted therapy in advanced non-small cell lung cancer[J].Mol Cancer,2018,17(1):38.
[14]陈蕊,赵达,王丽娜.非小细胞肺癌EGFR-TKI耐药机制及治疗策略[J].肿瘤防治研究,2017,44(3):225-230.
[15]李光骁,陈晓明.射频消融与微波消融治疗肺肿瘤的对比研究[J].临床放射学杂志,2017,36(5):724-727.