Abstract

背景与目的表皮生长因子受体(epidermal growth factor receptor, EGFR)突变的非小细胞肺癌(non-small cell lung cancer, NSCLC)是肺癌的一个重要亚型。EGFR突变的NSCLC患者合并恶性心包积液的发生率较高,但目前针对此型肺癌患者治疗方案的研究较少。方法本研究对我院2010年1月-2016年12月期间确诊的EGFR敏感突变的NSCLC合并恶性心包积液患者的临床资料和治疗情况进行回顾性分析,具体分为以下三组治疗模式:口服吉非替尼联合心包灌注羟基喜树碱组(吉非替尼/HCPT),静脉化疗联合心包灌注羟基喜树碱组(化疗/HCPT)及吉非替尼单药组,探讨不同治疗模式患者病情的转归。结果273例晚期EGFR敏感突变的NSCLC患者中,29例初诊时有心包积液,剔除6例少量心包积液无法取得细胞学分析的患者,共23例纳入分析。患者总中位心包内疾病无进展时间(progression-free survival, PFS)为247天;吉非替尼/HCPT组患者PFS(460天)优于化疗/HCPT组患者(94天),(P=0.008);吉非替尼/HCPT组患者的PFS优于吉非替尼单药组患者(131天),(P=0.032)。同时对肺部原发灶的治疗分析显示:吉非替尼/HCPT组患者疗效优于化疗/HCPT组患者(客观有效率:33.3% vs 12.5%;疾病控制率:86.7% vs 62.5%);吉非替尼/HCPT组与吉非替尼单药组的患者,肺部肿瘤疗效无差异。且三组均未观察到明显的不良反应。结论一线吉非替尼联合心包灌注羟基喜树碱治疗有助于延长EGFR突变合并恶性心包积液的晚期NSCLC患者心包内PFS,且患者耐受性好,无明显不良反应。因例数少,尚有待更多样本多中心前瞻性临床研究证实。

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