本文關(guān)鍵詞： 表皮生長因子受體 基因型 19外顯子缺失突變 21外顯子L858R突變 生存分析　出處：《昆明醫(yī)科大學》2016年博士論文　論文類型：學位論文

【摘要】：目的：研究常見的表皮生長因子受體突變基因型(19外顯子缺失突變與21外顯子L858R替代突變)對于晚期肺腺癌患者二線治療(二線靶向治療與二線化療)的影響。方法：收集昆明醫(yī)科大學第一附屬醫(yī)院及昆明醫(yī)科大學第三附屬醫(yī)院自2010年4月1日至2012年12月31日肺腺癌患者的臨床資料,其中包含一線化療進展后二線靶向治療患者128例及一線靶向治療進展后二線化療患者94例。收集的資料包括姓名、性別、年齡、ECOG評分、臨床分期、吸煙狀態(tài)、影像大體腫瘤類型、使用的表皮生長因子受體絡(luò)氨酸激酶抑制劑藥物類型及表皮生長因子受體突變亞型。入選病例需根據(jù)入選及排除標準進行選擇,入選標準包括：IIIb期或IV期肺腺癌;EGFR突變;年齡18-80歲,二線靶向治療組至少接受1周期化療;二線化療組需一線靶向治療進展；ECOG評分0-2分；預期生存大于3月；有可供評估的病灶。然后,對所有入選病例進行電話隨訪,并通過PACS系統(tǒng)回顧入選患者CT/MRI等影像資料以獲得患者生存信息及療效信息,所獲得資料信息輸入SPSS 19.0進行統(tǒng)計學分析。結(jié)果：經(jīng)一線化療進展的晚期肺腺癌患者接受二線表皮生長因子受體絡(luò)氨酸激酶抑制劑靶向治療時,19外顯子缺失突變較21外顯子L858R替代突變患者的無進展生存期及總生存期更長(Median PFS:8.1 Vs 6.8 months, P=0.002; Median OS:17.6 Vs 12.5 months, P=0.000)。而經(jīng)一線靶向治療進展的晚期肺腺癌患者行二線化療時,19外顯子缺失突變患者與21外顯子替代突變患者兩組人群的無進展生存期及總生存期類似：總生存期(Median 8.2 Vs.8.6月,P=0.865)及無進展生存期(Median 4.1 Vs.4.2月,P=0.837)。結(jié)論：經(jīng)一線化療進展的晚期肺腺癌患者接受二線表皮生長因子受體絡(luò)氨酸激酶抑制劑靶向治療時,19外顯子缺失突變較21外顯子L858R替代突變具有更好的生存；而經(jīng)一線靶向治療進展的晚期肺腺癌患者行二線化療時,19外顯子缺失突變患者與21外顯子替代突變患者兩組人群的生存結(jié)果相似。
[Abstract]:Aim: to study the effect of deletion mutation of exon 19 and L858R substitution mutation of EGF receptor mutation genotype on second-line therapy (second-line targeting therapy and second-line chemotherapy) in patients with advanced lung adenocarcinoma. Methods: the clinical data of patients with lung adenocarcinoma were collected from the first affiliated Hospital of Kunming Medical University and the third affiliated Hospital of Kunming Medical University from April 1st 2010 to December 31st 2012. The data included 128 cases of second-line targeted therapy after the progression of first-line chemotherapy and 94 cases of second-line chemotherapy after first-line targeted therapy. The data collected included name, sex, age and ECOG score, clinical stage, smoking status. The type of tumor, the drug type of epidermal growth factor receptor complex aminokinase inhibitor and the mutant subtype of epidermal growth factor receptor were selected according to the selection and exclusion criteria. The inclusion criteria included EGFR mutation in lung adenocarcinoma in stage II IIIb or IV; age 18-80 years old and the second line targeted therapy group received at least one cycle of chemotherapy; the second line chemotherapy group required a score of 0-2 points in the progress of first-line targeted therapy and ECOG score; the expected survival was greater than March; Then, all the patients were followed up by telephone, and the patients' CT/MRI and other imaging data were reviewed by PACS system to obtain the information of survival and curative effect. The obtained data were inputted into SPSS 19.0 for statistical analysis. Results: the exon deletion mutation of exon 19 in advanced lung adenocarcinoma patients undergoing first-line chemotherapeutic progress was detected after targeted therapy with 2-line epidermal growth factor receptor complex aminokinase inhibitor. The progressive survival time and total survival time of patients with L858R substitution mutation at exon 21 were longer than those of patients with median PFS:8.1 Vs 6.8 months, P0. 002; Median OS:17.6 Vs 12.5 months, P0. 0000.The deletion mutation of exon 19 was found in advanced lung adenocarcinoma patients with advanced lung adenocarcinoma treated by first-line targeted therapy. The progression-free survival and total survival of patients with exon 21 exon replacement mutation were similar: total survival time (mean 8.2 Vs.8.6 / month) and progressive survival time (Median 4.1 Vs.4.2 / month P0. 837). Conclusion: advanced lung adenocarcinoma developed by first-line chemotherapy is associated with advanced lung adenocarcinoma. The deletion mutation of exon 19 was better than that of L858R substitution mutation in exon 21 after targeted therapy with 2-line epidermal growth factor receptor complex aminokinase inhibitor. The survival results of patients with exon deletion mutation of exon 19 and patients with substitution mutation of exon 21 were similar to those of patients with advanced lung adenocarcinoma undergoing second-line chemotherapy.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R734.2

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本文編號：1545044