慢性阻塞性肺疾病（COPD）影响接受表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗的肺癌患者的生存：一项基于全国人群的队列研究。

Presence of Chronic Obstructive Pulmonary Disease (COPD) Impair Survival in Lung Cancer Patients Receiving Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor (EGFR-TKI): A Nationwide, Population-Based Cohort Study.

作者信息

Wu Chia-Che, Rau Kun-Ming, Lee Wei-Chieh, Hsieh Meng-Che, Liu Jia-Sin, Chen Yen-Yang, Su Harvey Yu-Li

机构信息

Division of Hematology Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung 83301, Taiwan.

Department of Hematology Oncology, E-Da Cancer Hospital and I-Shou University, College of Medicine, Kaohsiung 82445, Taiwan.

出版信息

J Clin Med. 2019 Jul 12;8(7):1024. doi: 10.3390/jcm8071024.

The emergence of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) caused a paradigm shift in the treatment of non-small cell lung cancer (NSCLC). Although several clinicopathologic factors to predict the response to and survival on EGFR-TKI were recognized, its efficacy has not been confirmed for patients with underlying pulmonary disease, such as chronic obstructive pulmonary disease (COPD). We conducted the study to evaluate the impact of COPD on survival for NSCLC patients that underwent EGFR-TKI treatment. The nationwide study obtained clinicopathologic data from the National Health Insurance Research Database in Taiwan between 1995 and 2013. Patients receiving EGRR-TKI were divided into COPD and non-COPD groups, and adjusted for age, sex, comorbidities, premium level and cancer treatments. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier analysis. In total, 21,026 NSCLC patients were enrolled, of which 47.6% had COPD. After propensity score (PS) matching, all covariates were adjusted and balanced except for age ( < 0.001). In the survival analysis, the median OS (2.04 vs. 2.28 years, < 0.001) and PFS (0.62 vs. 0.69 years, < 0.001) of lung cancer with COPD were significantly worse than those without COPD. Lung cancer patients on EGFR-TKI treatment had a worse survival outcome if patients had pre-existing COPD.

表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）的出现使非小细胞肺癌（NSCLC）的治疗发生了范式转变。尽管已经认识到一些预测EGFR-TKI反应和生存的临床病理因素，但其对患有潜在肺部疾病（如慢性阻塞性肺疾病（COPD））患者的疗效尚未得到证实。我们进行了这项研究，以评估COPD对接受EGFR-TKI治疗的NSCLC患者生存的影响。这项全国性研究从1995年至2013年台湾国民健康保险研究数据库中获取了临床病理数据。接受EGRR-TKI治疗的患者被分为COPD组和非COPD组，并根据年龄、性别、合并症、保费水平和癌症治疗进行了调整。通过Kaplan-Meier分析计算总生存期（OS）和无进展生存期（PFS）。总共纳入了21026例NSCLC患者，其中47.6%患有COPD。在倾向评分（PS）匹配后，除年龄外（<0.001），所有协变量均得到调整并达到平衡。在生存分析中，患有COPD的肺癌患者的中位OS（2.04年对2.28年，<0.001）和PFS（0.62年对0.69年，<0.001）明显低于无COPD的患者。如果肺癌患者预先存在COPD，接受EGFR-TKI治疗时生存结果更差。