| 肺腺癌对一代EGFR-TKIs原发耐药的危险因素分析 |
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| 引用本文： | 孔君,杨雪,解卫平,孔辉.肺腺癌对一代EGFR-TKIs原发耐药的危险因素分析[J].现代肿瘤医学,2021(6). |
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| 作者姓名： | 孔君 杨雪 解卫平 孔辉 |
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| 作者单位： | 南京市第二医院结核科;南京医科大学第一附属医院（江苏省人民医院）呼吸与危重症医学科 |
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| 基金项目： | 国家科技重大专项(编号:2018ZX10722301-002);国家自然科学基金(编号:81870054,81273571);江苏省卫生厅重点项目(编号:H201601)。 |
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| 摘 要： | 目的:分析对一代表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitors,EGFR-TKIs)原发耐药的EGFR突变肺腺癌患者的临床特征,为预测肺腺癌患者是否对一代EGFR-TKIs原发耐药提供依据。方法:收集2014年01月至2019年04月于本院住院,一线使用一代EGFR-TKIs且随访时间超过6个月的EGFR敏感突变(19Del/21L858R)肺腺癌患者,根据疗效纳入原发性耐药组(NR=40)和敏感组(NS=237),比较两组患者的临床、影像特征及实验室指标之间的差异,分析对一代EGFR-TKIs原发耐药的危险因素。结果:EGFR敏感突变患者的原发性耐药发生率为14.4%。原发性耐药组与敏感组患者相比,二者在吸烟指数(P=0.004)及淋巴结转移(P=0.03)的差异有统计学意义。血清神经元特异性烯醇化酶(neuron specific enolase,NSE)≥10.725 ng/mL、肿瘤直径≥3.55 cm的患者更易对一代EGFR-TKIs耐药(P<0.05),各因素AUC值分别为0.615、0.716。联合NSE+肿瘤直径两项指标时AUC为0.735(95%CI:0.665~0.804),联合NSE+肿瘤直径+吸烟指数三项指标时AUC为0.751(95%CI:0.679~0.822),均优于单项指标。多因素Logistics回归分析证实,血清NSE浓度、肿瘤直径及吸烟指数是预测EGFR敏感突变患者对一代EGFR-TKI原发耐药的独立影响因素(P<0.05)。结论:吸烟指数≥400、病灶直径≥3.55 cm、血清NSE浓度≥10.725 ng/mL的患者更易对一代EGFR-TKIs原发耐药。单因素对预测EGFR突变患者是否对一代EGFR-TKIs原发耐药准确性较低,综合上述三项指标预测效果更好。
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| 关 键 词： | EGFR 一代EGFR-TKIs 肺腺癌 原发性耐药 危险因素 |
Analysis of risk factors for first generation EGFR-TKIs resistance of lung adenocarcinoma |
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| KONG Jun,YANG Xue,XIE Weiping,KONG Hui.Analysis of risk factors for first generation EGFR-TKIs resistance of lung adenocarcinoma[J].Journal of Modern Oncology,2021(6). |
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| Authors: | KONG Jun YANG Xue XIE Weiping KONG Hui |
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| Affiliation: | (Department of Tuberculosis,the Second Hospital of Nanjing,Jiangsu Nanjing 211100,China;Department of Pulmonary and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Nanjing 210029,China) |
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| Abstract: | Objective:To analyze the clinical characteristics of the first generation of EGFR-TKIs resistant lung adenocarcinoma patients with EGFR mutation,provide basis for the selection of therapeutic agents for EGFR mutation patients.Methods:The clinical data of patients with lung adenocarcinoma admitted to the First Affiliated Hospital of Nanjing Medical University from January 2014 to April 2019 were retrospectively analyzed,following inclusion criteria:Patients applied first generation EGFR-TKIs as first-line treatment and followed up for more than 6 months.Based on the curative effect,patients were classified into the primary drug resistant(NR=40)and sensitive group(NS=237),then the clinical data of two groups of patients and progression-free survival after the treatment of TKIs were compared.Results:The incidence of primary resistance was 14.4%.There were statistically significant differences in smoking index(P=0.004)and lymph node metastasis(P=0.03).Patients with NSE≥10.725 ng/mL and tumor diameter≥3.55 cm were more likely to be resistant to first-generation EGFR-TKIs(P<0.05),and the AUC values of each factor were 0.615 and 0.716,respectively.Combined with NSE and tumor diameter,the AUC was 0.735(95%CI:0.665~0.804).Combined with NSE,tumor diameter and smoking index,the AUC was 0.751(95%CI:0.679~0.822),which was better than the single index.Multi-factor logistic regression analysis confirmed that smoking index,lesion diameter and serum NSE concentration were independent influencing factors for predicting primary EGFR-TKIs resistance in patients with EGFR-sensitive mutations(P<0.05).Conclusion:Those with smoking index≥400,lesion diameter≥3.55 cm and serum NSE concentration≥10.725 ng/mL are more likely to be resistant to the first-generation EGFR-TKIs.The prediction accuracy of primary resistance to first generation EGFR-TKIs is low,however the prediction model based on the three factors could improve the accuracy. |
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| Keywords: | EGFR first generation EGFR-TKIs lung adenocarcinoma primary resistance risk factors |
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