吉非替尼对比培美曲塞联合奈达铂新辅助治疗ⅢA-N2期表皮生长因子受体突变阳性肺腺癌病人的疗效

doi:10.3969/j.issn.1005-6483.2020.10.013

摘要/Abstract

摘要： 目的观察吉非替尼与培美曲塞联合奈达铂新辅助治疗ⅢA-N2期表皮生长因子受体(epidermal growth factor receptor，EGFR)突变阳性肺腺癌病人疗效与安全性。
方法 2015年1月～2019年5月初诊ⅢA-N2期EGFR突变肺腺癌病人89例，根据治疗用药的不同分为靶向治疗组（40例）与化疗组（49例），分别采用吉非替尼和培美曲塞联合奈达铂治疗；比较两组缓解率、组织学评级有效率、不良反应发生率、手术相关指标、术后并发症发生率以及随访生存率。
结果吉非替尼组治疗缓解率和组织学评级有效率均高于化疗组（P＜0.05）；吉非替尼组皮疹、腹泻、甲沟炎和口腔黏膜炎发生率均高于化疗组（P＜0.05），恶心、呕吐和骨髓抑制发生率均低于化疗组（P＜0.05），Ⅲ～Ⅳ级不良反应发生率低于化疗组（P＜0.05），转氨酶升高、周围神经炎发生率与化疗组无明显差异（P＞0.05）；两组手术切除率、手术时间、术中出血量及引流管留置时间比较差异无统计学意义（P＞0.05）；两组术后并发症发生率比较差异无统计学意义（P＞0.05）；吉非替尼组中位生存时间显著长于化疗组（P＜0.05）。
结论与化疗比较，新辅助吉非替尼治疗对ⅢA-N2期EGFR突变肺腺癌疗效确切，不良反应轻，中位生存时间显著延长。

关键词: 肺癌, 腺癌, 表皮生长因子受体, 新辅助治疗, 化疗

Abstract: Objective To observe and compare the efficacy and safety of gefitinib and pemetrexed combined with nedaplatin neoadjuvant in patients with stage ⅢA-N2 EGFR mutation-positive lung adenocarcinoma.
Methods Eighty-nine patients with stage ⅢA-N2 EGFR mutation lung adenocarcinoma who were newly diagnosed in our hospital from January 2015 to May 2019 were randomly divided into a targeted therapy group（40 cases）with Gefitinib and a chemotherapy group（49 cases）with pemetrexed combined with nedaplatin.Some items were compared by the two groups，including the remission rate，effective rate of histological grade，adverse reactions incidence，the levels of surgical-related clinical indicators，postoperative complications rate，and follow-up survival rate.
Results The remission rate and effective rate of histological grade of the were higher in the gefitinib group than in the chemotherapy group（P<0.05）.The incidence of rash，diarrhea，paronychia，and oral mucositis were higher in the gefitinib group than in the chemotherapy group（P<0.05）.The incidence of nausea，vomiting，and myelosuppression were lower in the gefitinib group than in the chemotherapy group（P<0.05），and the incidence of grade Ⅲ～Ⅳ adverse reactions were lower in the gefitinib group than in the chemotherapy group（P<0.05）.There was no statistical difference in the incidence of transaminase increased and peripheral neuritis between the two groups（P>0.05）.There was no significant difference in surgical resection rate，operation time，intraoperative blood loss，and drainage tube indwelling time between the two groups（P>0.05）.There was no statistically significant difference in the incidence of postoperative complications in the two groups（P>0.05）.The median OS was significantly longer in the gefitinib group than in the chemotherapy group（P<0.05）.
Conclusion Compared with chemotherapy，gefitinib for neoadjuvant therapy in treatment of patients with lung adenocarcinoma harboring EGFR mutant at stage ⅢA-N2 stage was effective exactly，reduced the incidence of adverse reactions and significantly prolonged median survival time.

Key words: lung cancer, adenocarcinoma, epidermal growth factor receptor, neoadjuvant therapy, chemotherapy

滕继平杨志胤胡晓华. 吉非替尼对比培美曲塞联合奈达铂新辅助治疗ⅢA-N2期表皮生长因子受体突变阳性肺腺癌病人的疗效[J]. 临床外科杂志, 2020, 28(10): 938-942.

TENG Jiping, YANG Zhiyin, HU Xiaohua.. The efficacy of gefitinib versus pemetrexed combined with nedaplatin in patients with stage ⅢA-N2 EGFR mutation-positive lung adenocarcinoma[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(10): 938-942.

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