肺腺癌对一代EGFR-TKIs原发耐药的危险因素分析

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 ki-nase 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0...

Analysis of risk factors for first generation EGFR-TKIs resistance of lung adenocarcinoma

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.