非小细胞肺癌患者再次活检和 EGFR 突变分析的可行性。
Feasibility of re-biopsy and EGFR mutation analysis in patients with non-small cell lung cancer.
机构信息
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, South Korea.
出版信息
Thorac Cancer. 2018 Jul;9(7):856-864. doi: 10.1111/1759-7714.12762. Epub 2018 May 14.
BACKGROUND
In cases of EGFR-tyrosine kinase inhibitor (TKI) failure, re-biopsy may be useful to understand resistance mechanisms and guide further treatment decisions. However, performing re-biopsy is challenging because of several hurdles. We assessed the feasibility of re-biopsy in advanced non-small cell lung cancer (NSCLC) patients in real-world clinical practice.
METHODS
We retrospectively reviewed the clinical and pathologic data of advanced NSCLC patients who experienced disease progression after previous treatment with EGFR-TKIs at a single tertiary hospital in Korea between January 2014 and December 2016. Re-biopsy specimens included small biopsy, surgical tissue, or liquid-based cytology. EGFR mutation was tested using peptide nucleic acid-mediated clamping PCR.
RESULTS
Of the 230 NSCLC patients that experienced progression after EGFR-TKI therapy, 105 (45.7%) underwent re-biopsy. Re-biopsy was successfully performed in 94 (89.5%) patients, and 11 patients were diagnosed with no malignancy. The complication rate was 8.6%, including seven cases of pneumothorax. EGFR mutation testing was performed on 75 patients using re-biopsy specimens. Of the 57 patients who had sensitizing mutations at diagnosis, T790M mutations were found in 19 (33.3%), while 38 (66.7%) had no T790M mutation. Multivariate analysis showed that the re-biopsy group was younger (P = 0.002) and exhibited a previous response to EGFR-TKIs (P < 0.001).
CONCLUSION
Re-biopsy in advanced NSCLC is feasible in real world clinical practice, particularly in younger patients and those who achieved a previous response to EGFR-TKIs.
背景
在表皮生长因子受体酪氨酸激酶抑制剂（TKI）治疗失败的情况下，重新进行活检可能有助于了解耐药机制，并指导进一步的治疗决策。然而，由于存在多种障碍，重新进行活检具有挑战性。我们评估了在韩国的一家三级医院的真实临床实践中，晚期非小细胞肺癌（NSCLC）患者重新进行活检的可行性。
方法
我们回顾性分析了 2014 年 1 月至 2016 年 12 月期间，在韩国的一家三级医院接受过 EGFR-TKI 治疗后疾病进展的晚期 NSCLC 患者的临床和病理数据。重新活检标本包括小活检、手术组织或液体基细胞学标本。采用肽核酸介导的夹式 PCR 检测 EGFR 突变。
结果
在 230 例接受 EGFR-TKI 治疗后疾病进展的 NSCLC 患者中，有 105 例（45.7%）接受了重新活检。在 94 例（89.5%）患者中成功进行了重新活检，11 例患者被诊断为无恶性肿瘤。并发症发生率为 8.6%，包括 7 例气胸。对 75 例患者使用重新活检标本进行了 EGFR 突变检测。在 57 例初诊时有敏感突变的患者中，发现 T790M 突变 19 例（33.3%），而 38 例（66.7%）无 T790M 突变。多变量分析显示，重新活检组患者年龄较小（P = 0.002），并且先前对 EGFR-TKIs 有反应（P < 0.001）。
结论
在真实世界的临床实践中，晚期 NSCLC 重新进行活检是可行的，特别是在年轻患者和那些先前对 EGFR-TKIs 有反应的患者中。
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