标题：吉非替尼靶向治疗EGFR阳性晚期非小细胞肺癌的疗效及对患者EGFR、Her-2、P-Akt和ERCC1的影响

      作者：黄婉兰，陈宏鹏，林春平    揭阳市人民医院化疗科，广东 揭阳 522000

      卷次： 2020年31卷11期

      【摘要】 目的 观察吉非替尼治疗人表皮生长因子受体(EGFR)阳性晚期非小细胞肺癌(NSCLC)的疗效，并探讨其对患者EGFR、人表皮生长因子受体 2 (Her-2)、磷酸化Akt (P-Akt)和切除修复交叉互补基因 1 (ERCC1)的影响。方法 选取揭阳市人民医院化疗科于2017年1月至2018年12月收治的90例EGFR阳性的晚期NSCLC患者进行研究，所有患者按照随机数表法分为观察组和对照组，每组45例。观察组给予吉非替尼治疗，对照组给予多西紫杉醇治疗，28 d为一个疗程，均治疗3个疗程。两组患者治疗后随访至2019年3月。在治疗结束6个月后比较两组患者的临床治疗效果、EGFR、Her-2、P-Akt和ERCC1表达水平，采用生存质量测定量表(QOL-100)评价生存质量，并观察不良反应发生情况。结果 治疗后，观察组患者的治疗总有效率和疾病控制率分别为44.44%，60.00%，明显高于对照组的 17.78%，33.33%，差异均有统计学意义(P<0.05)；治疗前，两组患者的 EGFR、Her-2、P-Akt和ERCC1表达水平比较差异均无统计学意义(P>0.05)；治疗后，两组患者的EGFR、Her-2及P-Akt表达水平均较治疗前明显降低，且观察组明显低于对照组，两组患者的ERCC1水平较治疗前明显升高，且观察组明显高于对照组，差异均有统计学意义(P<0.05)；治疗后，两组患者的心理、生活、环境、独立性、社会关系以及精神/个人信仰领域等生存质量评分较治疗前明显升高，且观察组患者的上述各项评分明显优于对照组，差异均有统计学意义(P<0.05)；治疗后，观察组患者的不良反应发生率为24.44%，略低于对照组的42.22%，但差异无统计学意义(P>0.05)；观察组患者治疗后6个月的死亡率为6.66%，略低于对照组的17.78%，但差异无统计学意义(P>0.05)。结论 吉非替尼治疗EGFR阳性晚期NSCLC患者的临床效果好，其能够明显改善患者的EGFR、Her-2及P-Akt表达水平以及生存质量，是目前EGFR阳性晚期NSCLC的标准一线治疗方案。
      【关键词】 晚期肺癌；非小细胞肺癌；基因突变；吉非替尼；表皮生长因子受体酪氨酸激酶抑制剂；临床疗效；不良反应
      【中图分类号】 R734.2 【文献标识码】 A 【文章编号】 1003—6350（2020）11—1373—04

Efficacy of gefitinib in the treatment of EGFR-positive advanced non-small cell lung cancer and its effects onEGFR, Her-2, P-Akt, and ERCC1.
HUANG Wan-lan, CHEN Hong-peng, LIN Chun-ping. Department ofChemotherapy, Jieyang People's Hospital, Jieyang 522000, Guangdong, CHINA
【Abstract】 Objective To study the efficacy of gefitinib in the treatment of EGFR-positive advanced non-smallcell lung cancer and its effects on epidermal growth factor receptor (EGFR), human epidermal growth factor receptor-2(Her-2), phosphorylated Akt (P-Akt), and excision repair cross-complementation group 1 (ERCC1), providing guidancefor patients' clinical diagnosis and treatment. Methods Ninety patients with advanced non-small cell lung cancer whowere positive for EGFR mutations were enrolled in Department of Chemotherapy, Jieyang People's Hospital from Janu-ary, 2017 to December 2018. All patients were randomly divided into observation group and control group according torandom number table method, with 45 patients in each group, with 28 days as a course of treatment, for 3 courses. Theobservation group was given gefitinib for treatment, and the control group was given docetaxel for treatment. The twogroups were followed up until March 2019. Six months after the end of treatment, the clinical effects, changes in EGFR,Her-2, P-Akt and ERCC1 expression levels were compared between the two groups. Quality of life was assessed usingthe Quality of Life Scale (QOL-100), and adverse reactions were observed between the two groups. Results After treat-ment, the total effective rate and disease control rate of the observation group were 44.44% and 60.00%, which were sig-nificantly higher than 17.78% and 33.33% of the control group (P<0.05). Before treatment, there was no significant dif-ference in the expression levels of EGFR, HER-2, p-Akt, and ERCC1 between the two groups (P>0.05); after treatment,the expression levels of EGFR, HER-2, and p-Akt in the two groups were significantly decreased, and the levels in theobservation group were significantly lower than those in the control group; ERCC1 level in the two groups was signifi-cantly increased, and the level in the observation group was significantly higher than that in the control group (P<0.05).After treatment, the quality of life scores in the two groups were significantly increased than those before treatment, andthe scores were significantly better in the observation group than in the control group (P<0.05). After treatment, the inci-