目的 分析一线、二线使用吉非替尼治疗表皮生长因子受体(EGFR)不同位点突变的晚期非小细胞肺癌(NSCLC)患者的疗效.方法 回顾性分析2013年1月至2014年12月山西省肿瘤医院接受吉非替尼治疗的EGFR不同位点突变的70例晚期NSCLC患者临床资料,按治疗方式分为一线治疗组(36例)和二线治疗组(34例);按基因突变类型可分为19号外显子缺失组(EGFR基因19号外显子LREA缺失,46例)和21号突变组(21号外显子L858R突变,24例).观察各组无进展生存(PFS)时间、有效率(ORR)、疾病控制率(DCR).结果 70例可评估患者中,19号外显子LREA缺失患者中位PFS时间8.88个月(95％CI 7.72～10.04),21号外显子L858R突变患者中位PFS时间8.67个月(95％CI 7.17～10.17),差异无统计学意义(P=0.959);19号外显子LREA缺失患者ORR为69.6％(32/46),21号外显子L858R突变患者ORR为54.2％(13/24),差异无统计学意义(χ2=1.629,P=0.202);19号外显子LREA缺失患者DCR为84.8％(39/46),21号外显子L858R突变患者DCR为91.7％(22/24),差异无统计学意义(χ2=0.194,P=0.659).一线治疗组中位PFS时间9.22个月(95％CI 7.92～10.52),二线治疗组中位PFS时间8.37个月(95％CI 7.08～9.65),差异无统计学意义(P=0.507);一线治疗组ORR为63.9％(23/36),二线治疗组ORR为58.8％(20/34),差异无统计学意义(χ2=1.460,P=0.227);一线治疗DCR为88.9％(32/36),二线治疗DCR为88.2％(30/34),差异无统计学意义(χ2=0.060,P=0.940).结论 NSCLC患者EGFR不同位点突变及一线、二线使用吉非替尼治疗近期疗效和无进展生存情况相近.%Objective To analyze the efficacy of gefitinib in the first-line and the second-line treatment of advanced non-small cell lung cancer (NSCLC) with different mutations of epidermal growth factor receptor (EGFR). Methods The clinical data of 70 patients with advanced NSCLC harboring different EGFR mutations and taking gefitinib as the first-line or the second-line treatment in Shanxi Provincial Cancer Hospital from January 2013 to December 2014 was analyzed retrospectively. According to the treatment method, the patients were divided into the first-line treatment group (36 cases) and the second-line treatment group (34 cases); according to the type of gene mutations, the patients were divided into exon 19 deletion group (EGFR gene exon 19 LREA deletion, 46 cases) and exon 21 mutation group (exon 21 L858R mutation, 24 cases). Progression-free survival (PFS), effective rate (ORR), and disease control rate (DCR) were observed in each group. Results Of the 70 evaluable patients, the median PFS time in patients with exon 19 LREA deletion was 8.88 months (95％ CI 7.72-10.04), and the median PFS time in patients with exon 21 L858R mutation was 8.67 months (95％ CI 7.17-10.17), the difference between the two groups was not statistically significant (P = 0.959). The ORR in patients with exon 19 LREA deletion was 69.6％ (32/46), and the ORR inpatients with exon 21 L858R mutation was 54.2％ (13/24), the difference was not statistically significant (χ 2= 1.629, P = 0.202). The DCR in patients with exon 19 LREA deletion was 84.8％ (39/46), and the DCR in patients with exon 21 L858R mutation was 91.7％ (22/24), the difference was not statistically significant (χ 2= 0.194, P = 0.659). The median PFS time in patients with the first-line treatment was 9.22 months (95％ CI 7.92-10.52), and the median PFS time in patients with the second-line treatment was 8.37 months (95％ CI 7.08-9.65), the difference was not statistically significant (P = 0.507). The ORR in patients with the first-line treatment was 63.9％ (23/36), and the ORR in patients with the second-line treatment was 58.8％ (20/34), the difference was not statistically significant (χ 2 = 1.460, P = 0.227). The DCR in patients with the first-line treatment was 88.9％ (32/36), and the DCR in patients with the second-line treatment was 88.2％ (30/34), the difference was not statistical significant (χ 2 = 0.060, P = 0.940). Conclusion The short-term efficacy and PFS are similar between NSCLC patients with different mutations of EGFR or with the first-line and the second-line treatment with gefitinib.
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