肺腺癌相关恶性胸腔积液中表皮生长因子受体突变状态与表皮生长因子受体酪氨酸激酶抑制剂的疗效。

EGFR Mutation Status in Lung Adenocarcinoma-Associated Malignant Pleural Effusion and Efficacy of EGFR Tyrosine Kinase Inhibitors.

机构信息

Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.

Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea.

出版信息

Cancer Res Treat. 2018 Jul;50(3):908-916. doi: 10.4143/crt.2017.378. Epub 2017 Sep 19.

DOI:10.4143/crt.2017.378

PMID:28934846

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6056963/

Abstract

PURPOSE

Malignant pleural effusions (MPEs) are often observed in lung cancer, particularly adenocarcinoma. The aim of this study was to investigate epidermal growth factor receptor (EGFR) mutation status in lung adenocarcinoma-associated MPEs (LA-MPEs) and its correlation with efficacy of EGFR tyrosine kinase inhibitor (TKI) therapy.

MATERIALS AND METHODS

Samples comprised 40 cell blocks of pathologically-confirmed LA-MPEs collected before the start of EGFR TKI therapy. EGFR mutation status was re-evaluated by peptide nucleic acid clamping and the clinical outcomes of EGFR TKI‒treated patients were analyzed retrospectively.

RESULTS

EGFR mutations were detected in 72.5% of LA-MPE cell blocks (29/40). The median progression-free survival for patients with EGFR mutations in LA-MPEs was better than that for patients with wild-type EGFR (7.33 months vs. 2.07 months; hazard ratio, 0.486; 95% confidence interval, 0.206 to 1.144; p=0.032). The objective response rate (ORR) of 26 patients with EGFR mutations in LA-MPEs among the 36 patients with measurable lesions was 80.8%, while the ORR of the 10 patients with wild-type EGFR in LA-MPEs was 10% (p < 0.001). Among the 26 patients with EGFR mutations in LA-MPEs, the ORR of target lesions and LA-MPEs were 88.5% and 61.5%, respectively (p=0.026).

CONCLUSION

EGFR mutation status in cell blocks of LA-MPEs confirmed by pathologic diagnosis is highly predictive of EGFR TKI efficacy. For patients with EGFR mutations in LA-MPEs, the response to EGFR TKIs seems to be worse for pleural effusions than for solid tumors.

摘要

目的

恶性胸腔积液（MPE）常发生于肺癌，尤其是肺腺癌。本研究旨在探讨肺腺癌相关胸腔积液（LA-MPE）中表皮生长因子受体（EGFR）突变状态及其与 EGFR 酪氨酸激酶抑制剂（TKI）治疗疗效的相关性。

材料与方法

纳入 40 例经病理证实的 LA-MPE 细胞块标本，均在开始 EGFR TKI 治疗前采集。采用肽核酸夹心法重新评估 EGFR 突变状态，并回顾性分析 EGFR TKI 治疗患者的临床结局。

结果

LA-MPE 细胞块中检测到 EGFR 突变 72.5%（29/40）。LA-MPE 中存在 EGFR 突变的患者中位无进展生存期长于 EGFR 野生型患者（7.33 个月比 2.07 个月；风险比，0.486；95%置信区间，0.206 至 1.144；p=0.032）。在 36 例可测量病灶患者中，LA-MPE 中存在 EGFR 突变的 26 例患者的客观缓解率（ORR）为 80.8%，而 LA-MPE 中存在 EGFR 野生型的 10 例患者的 ORR 为 10%（p < 0.001）。在 LA-MPE 中存在 EGFR 突变的 26 例患者中，靶病灶和 LA-MPE 的 ORR 分别为 88.5%和 61.5%（p=0.026）。