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目的探讨表皮生长因子受体(EGFR)基因突变对晚期肺腺癌患者培美曲塞疗效的影响。方法Ⅲb/Ⅳ期肺腺癌患者47例,接受培美曲塞联合铂类一线化疗。依据化疗前EGFR基因检测结果分为突变型20例(突变组)和野生型27例(野生组)。比较两组的客观有效率(ORR)、疾病控制率(DCR)、无进展生存期(PFS)和总生存期(OS)。结果 EGFR突变组ORR为45.0%,DCR为80.0%,稍高于野生组的33.3%和66.7%(P>0.05)。突变组的中位PFS为6个月(95%CI=5.27-6.73),长于野生组的3个月(95%CI=2.32-3.68)(P<0.01)。多因素分析结果显示,疾病控制情况和EGFR基因表达状态是影响PFS和OS的独立因素。结论培美曲塞联合铂类药物一线治疗晚期肺腺癌疗效确切。EGFR基因突变型患者的PFS延长。
Objective To investigate the effect of epidermal growth factor receptor (EGFR) gene mutation on the efficacy of pemetrexed in patients with advanced lung adenocarcinoma. Forty-seven patients with stage Ⅲb / Ⅳ lung adenocarcinoma received pemetrexed combined with platinum-based chemotherapy. According to the result of EGFR gene test before chemotherapy, there were 20 cases of mutation (mutation group) and 27 cases of wild type (wild group). The objective efficiency (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were compared between the two groups. Results The ORR of EGFR mutation group was 45.0% and the DCR was 80.0%, which was slightly higher than that of the wild group (33.3% and 66.7%, P> 0.05). The median PFS in the mutated group was 6 months (95% CI = 5.27-6.73), which was longer than 3 months in the wild group (95% CI = 2.32-3.68) (P <0.01). Multivariate analysis showed that disease control status and EGFR gene expression status were independent factors affecting PFS and OS. Conclusions Pemetrexed combined with platinum-based drugs is effective in the treatment of advanced lung adenocarcinoma. PFS prolongation in EGFR mutant patients.