摘要目的 探讨肺鳞癌患者表皮生长因子受体( EGFR)突变及EGFR酪氨酸激酶抑制剂( EGFR-TKI)的疗效.方法 收集2004年6月至2011年6月北京大学肿瘤医院胸部肿瘤内科治疗的79例晚期或术后复发的接受EGFR-TKI治疗的肺鳞癌患者,对其中67例患者进行组织或血浆EGFR19、21外显子突变检测,分析其与EGFR-TKI疗效的关系.结果 78例患者完成随访,1例失访(但可评价疗效及无进展生存期).79例中病情部分缓解6例(8％),稳定38例(48％),疾病控制率(DCR)为56％ (44/79),中位无进展生存期(mPFS)和中位总生存期(mOS)分别为3.7个月(95％ CI为2.0～5.0)和11.5个月(95％CI为6.6 ～14.2).67例进行基因突变检测的患者中,EGFR突变型31例,DCR为71％ (22/31),mPFS和mOS分别为6.3个月(95％C1为2.2～10.0)和13.5个月(95％CI为7.3～18.6).EGFR野生型36例,DCR为44％(16/36),mPFS和mOS分别为2.2个月(95％CI为1.1 ～4.0)和6.4个月(95％CI为4.0～12.0).在二线及以上治疗时接受EGFR-TKI治疗的EGFR突变患者中,厄洛替尼治疗组(17例)mPFS和mOS分别为7.9个月和15.8个月,吉非替尼治疗组(7例)均为6.3个月,两组比较差异无统计学意义(P＞0.05).Cox回归多因素分析结果显示,进行基因突变检测的67例患者的EGFR突变与无进展生存期、总生存期相关(均P＜0.05)；采用x2检验比较基因突变型与野生型两组的疗效,显示突变组进展风险明显低于野生组(P＜0.05).结论 EGFR基因突变的肺鳞癌患者仍可从EGFR-TKI治疗中获益,但疗效比EGFR突变的肺腺癌患者差.厄洛替尼的疗效优于吉非替尼,但差异无统计学意义.

abstractsObjective To investigate the frequency of epidermal growth factor receptor(EGFR) mutations and their correlation with the efficacy of tyrosine kinase inhibitors (EGFR-TKI) in advanced squamous cell lung cancer.Methods This retrospective study enrolled 79 patients with advanced squamous cell lung cancer who received EGFR-TKI at Department of Thoracic Medical Oncology in Peking University Cancer Hospital from June 2004 to June 2011.Among them,67 patients had tissue and/or plasma EGFR exon 19 and 21 mutation detection in order to make an analysis on the relationship between EGFR mutation and the TKI's effect.Results The disease control rate (DCR) was 56％ in all the patients.The median progression free survival (mPFS) and median overall survival (mOS) was 3.7 months (95％ CI:2.0 -5.0) and 11.5 months (95％ CI:6.6- 14.2),respectively.Of the 67 patients who received EGFR mutation detection,there were 31 patients harboring EGFR-mutation,for whom the DCR was 71％ (22/31),and mPFS and mOS was 6.3 months (95％ CI:2.2 - 10.0) and 13.5 months (95％ CI:7.3 -18.6) respectively.36 patients' EGFR status were wild type,for whom the DCR was 44％ (16/36),mPFS and mOS was 2.2 months ( 95 ％ CI:1.1 - 4.0 ) and 6.4 months ( 95 ％ CI:4.0 - 12.0 ).There were 17 patients who received erlotinib and 7 patients who received gefitinib as second or more line treatment.mPFS and mOS were 7.9 months and 15.8 months in the erlotinib group,respectively; and the mPFS and mOS were both 6.3 months in gefitinib group; the difference between the 2 groups did not reach statistical significance.Cox-regression analysis showed that EGFR mutation was significantly correlated with PFS and OS (P ＜ 0.05,respectively).EGFR mutation was significantly correlated with DCR by Chi-square test,P ＜0.05. Conclusions EGFR mutation was a predictor for advanced squamous cell lung cancer to EGFR-TKI.However,the effect was inferior in advanced squamous cell lung cancer as compared to lung adenocarcinoma.Erlotinib tended to be superior to gefitinib.