ABSTRACT
Objective:To investigate the influencing factors of the therapeutic effect of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in patients with epidermal growth factor receptor (EGFR) mutant advanced non-small cell lung cancer (NSCLC).Methods:The clinical data of 104 EGFR mutant advanced NSCLC patients who received EGFR-TKI treatment in Wuxi No.2 Hospital Affiliated to Nanjing Medical University from January 2015 to October 2019 were collected. The correlation of different types of EGFR mutation with the clinicopathological characteristics, the hematological examination results and the treatment mode of patients was analyzed. Cox proportional hazard model was used to analyze the association of the progression-free survival (PFS) time of patients receiving EGFR-TKI treatment with the different types of EGFR mutation, the clinicopathological characteristics, hematological related indexes and treatment mode. Kaplan-Meier method was used to analyze the independent influencing factors for the PFS of the stratified patients.Results:The overall disease control rate (DCR) of patients receiving EGFR-TKI treatment was 92.3% (96/104). Cox univariate analysis showed that the levels of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), D-dimer, and previous surgical treatment history of patients receiving EGFR-TKI treatment were associated with PFS of patients (all P < 0.05). Cox multi-factor analysis showed that EGFR mutation type ( HR =2.371, 95% CI 1.298-4.332, P = 0.005), combination therapy ( HR = 0.489, 95% CI 0.245-0.978, P = 0.043) and choice of therapeutic drugs ( HR = 0.261, 95% CI 0.113-0.606, P = 0.002) were independent influencing factors for the PFS of patients receiving EGFR-TKI treatment. The PFS of EGFR 19 exon-mutant patients with advanced NSCLC was longer than that of those with EGFR 21 exon-mutant (median PFS time: 14.0 months vs.9.5 months, P<0.05); the PFS of combination of radiotherapy or chemotherapy was longer than that of EGFR-TKI single therapy (median PFS time: 15.0 months vs. 9.0 months, P<0.05), the PFS of patients receiving erlotinib was better than that of those receiving gefitinib ( P<0.05). According to EGFR mutation types, it was found that EGFR 19 exon-mutant patients receiving EGFR-TKI in first-line treatment could obtain better PFS than those who receiving EGFR-TKI in second-line and above treatment (median PFS time: 14.0 months vs. 9.5 months, P<0.05). When receiving EGFR-TKI, EGFR 19 exon-mutant patients with CA125 <85 U/ml could obtain longer PFS time than those with CA125 ≥85 U/ml (median PFS time: 14.0 months vs. 6.5 months, P<0.05). Conclusions:The therapeutic effect of EGFR-TKI in EGFR-mutant patients with advanced NSCLC is positive. EGFR 19 exon-mutant NSCLC patients with low-level CA125 receiving EGFR-TKI in first-line treatment can obtain better PFS.
ABSTRACT
Objective:To investigate the relationship between neutrophil-to-lymphocyte ratio(NLR) and the type of epidermal growth factor receptor(EGFR) mutation and clinical characteristics in patients with advanced non-small cell lung cancer(NSCLC).Methods:From January 2017 to July 2019, the hematological detection, gene detection and clinical characteristics of 192 EGFR-mutant patients of advanced NSCLC in the Second Hospital of Wuxi Affiliated to Nanjing Medical University were collected and reviewed.The peripheral blood NLR and clinical characteristics in patients with different types of EGFR mutation.(including exon 19 and 21 mutation) were compared.Results:In this study, there were 192 NSCLC patients with EGFR mutation, including 90 patients with EGFR mutation in exon 19(46.87%), aged (67.7±12.8)years old; 84 patients with EGFR mutation in exon 21(43.75%), aged (66.6±9.3)years old; 18 patients with other types of EGFR mutation(9.38%), aged (72.5±10.5)years old.The average age of patients with other types of EGFR mutation was relatively older compared with those in exon 19 or 21 mutation, but there was no statistically significant difference( F=2.90, P>0.05). The patients with EGFR exon 19 mutation were more likely to occur in the right side(48/90) compared with EGFR exon 21 mutation(54/84), and there was statistically significant difference between the two groups(χ 2=5.45, P<0.05). However, the average NLR was (3.98±4.02) in patients with mutation in exons 19, (3.29±1.63) in patients with mutation in exons 21, and (5.32±3.48) in patients with other types of mutations.Compared with the average NLR in exon 21 mutation, the average NLR in patients with non 19 and 21 common mutations was relatively higher, but there was no statistically significant difference( F=3.51, P>0.05). According to the median NLR of 2.9, all cases were divided into two groups: NLR≤2.9 was low NLR group(99 cases), and NLR>2.9 was high NLR group(93 cases). There were statistically significant differences in sex, smoking history, pathological type, eastern cooperative oncology group (ECOG) score, brain metastasis, pleura metastasis and carcinoembryonic antigen(CEA) level between high and low NLR groups(χ 2=4.52, 9.01, 10.05, 9.07, 5.89, 9.03, 19.53, all P<0.05). However, there were no statistically significant differences in age and bone metastasis between high and low NLR groups(χ 2=1.56, 1.51, all P>0.05). Conclusion:Sex, smoking history, pathological type, ECOG score, brain metastasis, pleura metastasis and CEA levels are correlated with NLR level in advanced NSCLC patients.There is certain reference value of the primary focal site in distinguishing EGFR mutation types.However, there is no correlation between NLR level and EGFR mutation type.