摘要
目的统计表皮生长因子受体(EGFR)突变阳性的晚期非小细胞肺癌(NSCLC)患者选择吉非替尼一线治疗的耐药时间,收集临床资料,探讨吉非替尼耐药时间的影响因素。方法回顾性选取2015年1月至2019年10月中国医科大学附属盛京医院就诊的符合入选标准的患者110例,根据患者耐药时间分为耐药(耐药时间≤6个月)、中度敏感(6个月<耐药时间≤12个月)、敏感(耐药时间>12个月)3组,分析性别、年龄、吸烟史、癌胚抗原(CEA)、细胞角蛋白19片段(CY211)、神经元特异性烯醇化酶(NSE)、中性粒/淋巴细胞比值(NLR)、乳酸脱氢酶(LDH)、血红蛋白(Hb)、肿瘤最大径、是否有胸腔积液、器官转移情况(肺、骨、肝、肾上腺)、肿瘤TNM分期、EGFR突变类型与耐药时间的关系。结果110例患者中男31例,女79例;年龄33~86岁,平均年龄(60.85±9.98)岁;耐药组20例,中度敏感组54例,敏感组36例。单因素分析显示,年龄≥65岁、CY211、NLR≥4、高LDH、肝转移在不同耐药时间组间差异有统计学意义(P<0.05)。多因素Spearman相关性分析显示,年龄≥65岁与耐药时间呈正相关关系,年龄大者预示着耐药时间较长;CY211、NLR≥4、高LDH、肝转移与耐药时间呈负相关关系,高CY211、高NLR、高LDH、肝转移预示着耐药时间较短。多元有序Logistic回归分析显示,年龄<65岁、NLR≥4、肝转移是耐药时间短的独立危险因素。结论EGFR突变阳性的晚期NSCLC患者选择吉非替尼一线治疗后的耐药时间与年龄、CY211、NLR、LDH、肝转移相关,其中年龄<65岁、NLR≥4、肝转移是耐药时间短的独立危险因素。
Objective To investigate the time of drug resistance of patients with advanced non-small cell lung cancer(NSCLC)who were positive for EGFR mutation and chose gefitinib as first-line treatment,and collect clinical data to explore the influencing factors of drug resistance time of gefitinib.Methods From January 2015 to October 2019,110 patients in Shengjing Hospital Affiliated to China Medical University were retrospectively selected.According to the drug resistance time,the patients were divided into three groups:drug resistance(drug resistance time less than or equal to 6 months),moderate sensitivity(drug resistance time more than 6 months,less than or equal to 12 months)and sensitivity(drug resistance time more than 12 months)to analyze the relationship between the factors[sex,age,smoking history,carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CY211),neuron specific enolase(NSE),ratio of neutrophils/lymphocytes(NLR),lactate dehydrogenase(LDH),hemoglobin(Hb),maximum diameter of tumor,being with or without pleural effusion,organ metastasis(lung,bone,liver,adrenal gland),TNM stage of tumor and EGFR mutation type]and the drug resistance time.Results Among the 110 patients,31 were male and 79 were female;the minimum age was 33 years old,the maximum age was 86 years old,and the mean age was(60.85±9.98)years old;20 cases were in the drug resistance group,54 cases were in the moderate sensitivity group and 36 cases were in the sensitivity group.Univariate analysis showed that age≥65,CY211,NLR≥4,high LDH and liver metastasis were significantly different in different drug resistance time groups(P<0.05).Multivariate Spearman correlation analysis showed that the age≥65 years old was positively correlated with the time of drug resistance,and the older patients indicated a longer time of drug resistance;CY211,NLR≥4,high LDH and liver metastasis were negatively correlated with the time of drug resistance,and high CY211,high NLR,high LDH and liver metastasis indicated a shorter time of drug resistance.Multiple logistic regression analysis showed that age<65 years old,NLR≥4 and liver metastasis were independent risk factors for the short time of drug resistance.Conclusion The drug resistance time of patients with NSCLC who are positive for EGFR mutation after first-line treatment with gefitinib is related to age,CY211,NLR,LDH and liver metastasis,and age<65 years old,NLR≥4 and liver metastasis are independent risk factors for short drug resistance time.
作者
徐佳欢
王新年
黄新
赵立
徐小嫚
XU Jia-huan;WANG Xin-nian;HUANG Xin;ZHAO Li;XU Xiao-man(Department of Pulmonary and Critical Care Medicine,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《实用药物与临床》
CAS
2020年第3期224-229,共6页
Practical Pharmacy and Clinical Remedies
关键词
晚期非小细胞肺癌
吉非替尼
耐药时间
临床分析
Advanced non-small cell lung cancer
Gefitinib
Time of drug resistance
Clinical analysis
