Objective: To investigate the clinical effects of first generation epithelial growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) compared with platinum-based chemotherapy as first-line therapy in advanced lung adenocarcinoma patients with uncommon EGFR mutations. Methods: Clinical data of 4 276 patients diagnosed as advanced lung adenocarcinoma (ⅢB/Ⅳ) underwent EGFR gene detection at the Affiliated Cancer Hospital of Zhengzhou University from January 2012 to February 2018 were collected and 99 cases with uncommon EGFR mutations were selected. The clinical pathological features, treatment outcomes, treatment options and prognosis after first-line treatment of the 99 cases were analysed and compared with other patients with common EGFR mutations. Results: The objective response rates of patients with uncommon EGFR mutations receiving EGFR-TKIs or platinum-based chemotherapy were 33.0% and 27.1%, respectively. The disease control rates were 76.5% and 87.5%, respectively. The progression-free survival (PFS) of patients treated with EGFR-TKIs was 7.2 months, significantly superior than 4.9 months of patients receiving chemotherapy (P=0.009). The overall survival of patients treated with EGFR-TKIs was 14.3 months, significantly worse than 20.7 months of patients receiving chemotherapy (P=0.034). Multivariate analysis showed that distant metastases (P=0.001) and smoking history (P=0.013) were independent prognostic factors for OS of lung adenocarcinoma patients with EGFR uncommon mutations. Conclusions: Compared with chemotherapy, the usage of first generation of EGFR-TKIs as first-line therapy can improve the short-term efficacy of advanced lung adenocarcinoma patients with EGFR uncommon mutations. However, platinum-based chemotherapy shows a longer overall survival.
目的： 探讨表皮生长因子受体酪氨酸激酶抑制剂(EGFR－TKIs)和含铂化疗一线治疗表皮生长因子受体(EGFR)罕见突变晚期肺腺癌患者的临床疗效。 方法： 收集2012年1月至2018年2月间，在郑州大学附属肿瘤医院经EGFR基因检测的4 276例晚期(ⅢB～Ⅳ期)肺腺癌患者的临床资料，从中筛选出99例EGFR罕见突变患者的组织样本，分析其临床病理特征，一线治疗效果、一线治疗进展后患者的治疗情况和预后。分析EGFR常见突变和罕见突变患者的预后。 结果： EGFR－TKIs和含铂化疗一线治疗EGFR罕见突变患者的客观缓解率分别为33.0%和27.1%，疾病控制率分别为76.5%和87.5%，差异均无统计学意义(均P>0.05)；中位无进展生存时间分别为7.2和4.9个月，差异有统计学意义(P＝0.009)；总生存时间(OS)分别为14.3和20.7个月，差异有统计学意义(P＝0.034)。多因素分析显示，远处转移和吸烟史为影响EGFR罕见突变肺腺癌患者OS的独立因素(均P<0.05)。 结论： 对于EGFR罕见突变的晚期肺腺癌患者，一线使用第一代EGFR－TKIs与含铂化疗比较，可改善患者的近期疗效，但一线含铂化疗的患者生存时间更长。.
Keywords: Chemotherapy; Epithelial growth factor receptor tyrosine kinase inhibitors; Lung adenocarcinoma; Prognosis; Uncommon mutation.