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目的对晚期非小细胞肺癌(NSCLC)患者经靶向药物酪氨酸激酶抑制剂(EGFR-TKI)治疗,考察表皮生长因子受体(EGFR)基因不同位点突变患者的预后情况。方法入选69例Ⅲb~Ⅳ期NSCLC患者,按EGFR突变基因情况分为EGFR基因突变型21例(试验组)和EGFR基因野生型48例(对照组)。试验组按基因突变位点不同又分为3组:外显子19突变者11例(试验I组),外显子21突变8例(试验II组),外显子20突变2例(试验Ⅲ组)。试验组标准化疗+盐酸厄洛替尼片150 mg,每日1次,直至病情进展;对照组接受标准化疗方案治疗。全部患者均随访1~2年,评估近期疗效指标(有效率、疾病控制率),考察无进展生存率、1.5年生存率等生存指标。结果治疗后,试验组和对照组有效率分别为85.7%,52.1%;疾病控制率分别为90.5%,64.6%;试验组3个亚组的有效率分别为72.7%,50.0%,0%,差异均有统计学意义(P<0.05)。随访1.5年时,试验组和对照组无进展生存率分别为28.6%,8.3%;总生存率分别为47.6%,16.7%;试验组3个亚组患者的无进展生存率分别为90.9%,75.0%,50.0%和总生存率分别为100.0%,75.0%,50.0%,差异均有统计学意义(P<0.05)。试验组外显子19突变者的治疗效果和预后更好。结论 EGFR基因突变的NSCLC患者经EGFR TKI治疗后临床疗效好,但EGFR基因不同位点突变患者的预后有差异性。
Objective To investigate the prognosis of patients with advanced non-small cell lung cancer (NSCLC) treated with targeted drug tyrosine kinase inhibitor (EGFR-TKI) and to investigate the prognosis of patients with mutations in epidermal growth factor receptor (EGFR) gene. Methods Sixty-nine patients with stage Ⅲb-Ⅳ NSCLC were divided into two groups according to their EGFR mutation: 21 cases of EGFR gene mutation and 48 cases of EGFR gene wild type (control group). The experimental group was divided into 3 groups according to the different gene mutation sites: 11 cases of exon 19 mutation (test group I), 8 cases of exon 21 mutation (test group II) and 2 cases of exon 20 mutation (test Group Ⅲ). The experimental group standard chemotherapy + erlotinib hydrochloride tablets 150 mg, day 1, until the disease progression; the control group received standard chemotherapy regimen. All patients were followed up for 1 to 2 years to evaluate the recent efficacy indicators (effective rate, disease control rate), to investigate the progression-free survival rate, 1.5-year survival rate and other survival indicators. Results After treatment, the effective rates of the experimental group and the control group were 85.7% and 52.1% respectively; the disease control rates were 90.5% and 64.6% respectively; the effective rates of the three subgroups in the experimental group were 72.7%, 50.0% and 0% The differences were statistically significant (P <0.05). The follow-up of 1.5 years, the progression-free survival rate of the experimental group and the control group were 28.6% and 8.3% respectively; the overall survival rate was 47.6% and 16.7% respectively; the progression-free survival rates of the three subgroups in the experimental group were 90.9% 75.0%, 50.0% and overall survival rates were 100.0%, 75.0% and 50.0%, respectively, with significant differences (P <0.05). The experimental group of exon 19 mutations in the treatment effect and prognosis better. Conclusion The clinical efficacy of EGFR TKI therapy in NSCLC patients with EGFR gene mutation is good, but the prognosis of patients with mutations in EGFR gene is different.