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目的探讨生活方式对老年非小细胞肺癌(NSCLC)患者吉非替尼治疗的影响。方法将组织学证实的ⅢB～Ⅳ的65岁及以上的老年NSCLC患者,分为吉非替尼敏感组和耐药组。吉非替尼敏感是指患者用吉非替尼治疗时获得客观疗效或疾病稳定时间持续4个月以上,或患者EGFR19、21外显子突变;耐药患者是指鳞癌患者,EGFR是野生型或用吉非替尼治疗4个月内出现疾病进展。调查问卷内容包括吸烟情况(吸烟者或二手烟者),职业接触,是否在家里做饭,居住地是城市还是农村。对于诊断时就是晚期的患者,患者的总生存时间从诊断时计算;对术后完全切除的患者生存时间从发现疾病复发时计算。结果 65岁及以上患者共114例,患者的平均年龄72.34岁(65～86岁),男女比例为66:48。腺癌患者96例,鳞癌患者17例。多因素回归分析显示,老年NSCLC患者吉非替尼的疗效不佳预测因素是鳞癌(风险比7.33,P=0.01),在家做饭(风险比15.19,P=0.000)。而女性(风险比0.19,P=0.000)、不吸烟(风险比0.11,P=0.000)、有职业暴露(风险比0.19,P=0.000)是吉非替尼治疗敏感的预测指标。吉非替尼敏感型42例,占36.84%,耐药型72例,占63.16%,两组患者的中位生存时间分别为28.39个月和10.84个月(P=0.0006)。有利于患者生存的预后因素是吉非替尼治疗有效(风险比0.25,P=0.016),不利于患者生存的预后因素是合并慢性肺部疾病(风险比6.32,P=0.01)。结论吉非替尼有效的预测因素是女性、不吸烟、有职业暴露,治疗无效的预测因素是鳞癌和在家做饭。吉非替尼治疗有效和无效患者的中位生存期有明显差异,但需要大样本调查进一步明确结果。
Objective To investigate the effect of lifestyle on gefitinib in elderly patients with non-small cell lung cancer (NSCLC). Methods Histologically confirmed patients with NSCLC aged 65 years and older in stage ⅢB-Ⅳ were divided into gefitinib-sensitive group and drug-resistant group. Gefitinib sensitivity refers to patients with gefitinib treatment to obtain the objective effect or stable disease duration of 4 months or more, or patients with EGFR19,21 exon mutations; drug-resistant patients are squamous cell carcinoma, EGFR is wild Type or with gefitinib treatment of disease progression within 4 months. The questionnaire included smoking (smoker or secondhand smoker), occupational exposure, whether to cook at home, whether the place of residence is city or rural. For patients who are late on diagnosis, the patient’s overall survival time is calculated from the diagnosis; the survival time for patients who have undergone complete resection is calculated from the time when the disease is found to have relapsed. Results A total of 114 patients aged 65 and over were enrolled. The mean age of patients was 72.34 years (65-86 years), with a 66:48 male / female ratio. 96 cases of adenocarcinoma, squamous cell carcinoma in 17 cases. Multivariate regression analysis showed that poor predictive efficacy of gefitinib in elderly patients with NSCLC was squamous cell carcinoma (hazard ratio 7.33, P = 0.01), cooking at home (hazard ratio 15.19, P = 0.000). Female (hazard ratio 0.19, P = 0.000), no smoking (hazard ratio 0.11, P = 0.000), and occupational exposure (hazard ratio 0.19, P = 0.000) were sensitive predictors of treatment with gefitinib. Gefitinib sensitized 42 cases, accounting for 36.84%, resistant 72 cases, accounting for 63.16%, the median survival time was 28.39 months and 10.84 months (P = 0.0006). The prognostic factor for patient survival was gefitinib (hazard ratio 0.25; P = 0.016). The prognostic factor for survival was associated with chronic lung disease (hazard ratio 6.32, P = .01). Conclusion The effective predictors of gefitinib are female, nonsmoking, occupational exposure, and predictors of ineffective treatment are squamous cell carcinoma and home cooking. The median survival of patients with gefitinib was significantly different, but large sample surveys were needed to confirm the results.