单中心真实世界数据分析：表皮生长因子受体常见和少见突变型非小细胞肺癌靶向治疗疗效比较

王玉颖; 燕翔; 董周寰; 魏子涵; 管静芝

doi:10.3969/j.issn.2095-5227.2023.05.002

单中心真实世界数据分析：表皮生长因子受体常见和少见突变型非小细胞肺癌靶向治疗疗效比较

Targeted therapy for common- versus rare-mutations of epidermal growth factor receptor in non-small cell lung cancer: A single center analysis of real-world data

摘要

摘要:
背景表皮生长因子受体(epidermal growth factor receptor，EGFR)常见突变型非小细胞肺癌(non-small cell lung cancer，NSCLC)患者靶向治疗疗效与少见突变患者存在差距，真实世界鲜有对两者疗效进行直接对比的研究。
目的评估应用酪氨酸激酶抑制剂(tyrosine kinase inhibitors，TKIs)靶向治疗对EGFR常见突变及少见突变患者临床预后的影响，并分析影响临床预后的因素。
方法回顾性分析2019年8月1日 - 2021年12月31日在解放军总医院第一医学中心接受EGFR-TKIs治疗的EGFR常见、少见突变型晚期NSCLC患者临床资料，对两组患者的客观缓解率(objective response rates，ORR)、疾病控制率(disease control rates，DCR)、无进展生存期(progression-free survival，PFS)进行分析。
结果共99例患者纳入研究，EGFR常见突变79例，少见突变20例。常见突变组ORR为63.3%，DCR为93.7%；少见突变组ORR为35.0%，DCR为65.0%；EGFR常见突变组疗效优于少见突变组(P＜0.05)。Cox回归分析提示EGFR突变类型是影响NSCLC患者PFS的独立因素(P＜0.05)，Kaplan-Meier生存分析提示常见突变与少见突变患者接受靶向治疗预后差异较大(中位PFS：13.3个月 vs 6.0个月，P=0.006)。
结论与常见突变相比，少见突变患者靶向治疗疗效和预后均较差。

Abstract:
Background Patients with non-small cell lung cancer (NSCLC) with common or rare epidermal growth factor receptor (EGFR) mutations differ in the response to targeted therapy, but there are few direct comparisons in the real world.
Objective To evaluate the effect of tyrosine kinase inhibitors (TKI) on the clinical prognosis of patients with common mutations and rare mutations of EGFR, and address the factors affecting the clinical prognosis.
Methods Clinical data about patients with common or rare EGFR mutated NSCLC who received EGFR-TKIs in the First Medical Center of Chinese PLA General Hospital from August 1, 2019 to December 31, 2021 were collected for retrospective analysis. The objective response rate (ORR), disease control rate (DCR) and progression-free survival (PFS) of the two groups were analyzed.
Results A total of 99 patients were included in the study, including 79 common mutations in EGFR and 20 rare mutations. The common mutation group had an ORR of 63.3% and a DCR of 93.7%. In the rare mutation group, ORR was 35.0% and DCR was 65.0%, the curative effect of patients with common EGFR mutations was better than that of patients with rare EGFR mutations (P＜0.05). Cox regression analysis suggested that EGFR mutation type was an independent factor affecting PFS in the NSCLC patients (P<0.05). Kaplan Meier survival analysis showed that there was a significant difference in the prognosis of patients with common mutations and patients with rare mutations receiving targeted therapy (median PFS: 13.3 months vs 6.0 months, P=0.006).
Conclusion Patients with rare mutations have poorer outcomes and prognosis than those with common mutations.

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