吉非替尼治疗肺腺癌脑转移的临床观察

目的本研究拟分层探讨吉非替尼治疗肺腺癌脑转移的疗效及不良反应。方法回顾分析60例肺腺癌脑转移患者的临床资料,所有患者均口服吉非替尼250 mg/d,直到疾病进展、死亡或发生不可耐受的不良反应,分析其临床疗效及不良反应。结果全组60例患者的中位生存时间(median overall survival,m OS)和中位无进展生存时间(median progression-free survival,m PFS)分别为23.7个月和10.8个月,有效率(response rate,RR)和疾病控制率(disease control rate,DCR)分别为61.5%和91.8%。吉非替尼用于初治患者的m OS和m PFS分别为33.6个月和11个月,RR和DCR分别为74.0%和100.0%。吉非替尼用于复治患者的m OS和m PFS分别为17.2个月和5.8个月,RR和DCR分别为49.0%和81.3%。EGFR敏感性突变患者的m OS和m PFS分别为23.8个月和10.0个月,RR和DCR分别为74.0%和100.0%。EGFR突变状态不明患者的m OS和m PFS分别为34.6个月和11.3个月,RR和DCR分别为52.3%和85.7%。全组患者均耐受性良好,未发生严重不良反应。常见的不良反应包括:皮疹28例(46.7%)、肝功能不全4例(6.7%)、腹泻12例(20.0%)、口腔溃疡2例(3.3%)。结论吉非替尼治疗肺腺癌脑转移有效率较高,耐受性良好,尤其对初治、EGFR敏感突变的肺腺癌脑转移患者是一种更佳的治疗选择。     

EGFR-TKI治疗化疗失败后的Ⅳ期NSCLC的疗效及预后分析

目的回顾性分析EGFR-TKI治疗化疗失败后的Ⅳ期非小细胞肺癌的临床资料,探讨影响EGFRTKI疗效和预后的相关因素。方法收集福建省肿瘤医院2012年1月~2015年1月诊治的88例经病理学或细胞学证实的化疗失败后的Ⅳ期非小细胞肺癌口服EGFR-TKI治疗的临床资料,观察临床特征、治疗效果及生存时间。应用SPSS20.0软件进行统计学分析。结果全组患者88例,客观缓解率(ORR)为52.3%(46/88),疾病控制率(DCR)90.9%(80/88)。ECOG评分0,1分的ORR高于ECOG评分≥2者,83.3%vs30.8%,P=0.00;有吸烟史的ORR率低于无吸烟史,33.3%vs 60.7%,P=0.011;而年龄、性别、病理类型、敏感突变或突变状态未知、EGFR-TKI治疗时机等不影响EGFR-TKI近期疗效。全组患者中位无进展生存期为10.0个月,(95%CI 8.56~11.43)个月,中位总生存期为25个月(95%CI:19.64~30.36)个月。EGFR突变的患者42例(19del 24例,21 L858R 18例)中,EGFR19del突变的PFS优于L858R突变(12.0个月vs 8.0个月,P=0.010)。单因素分析显示,ECOG评分、吸烟史影响PFS及OS。ECOG评分0,1分的PFS、OS长于ECOG评分≥2分者(分别为12.0个月vs 6.0个月,P=0.000;40.0个月vs 19.0个月,P=0.000),无吸烟史的PFS、OS长于有吸烟史组(分别为10.0个月vs 6.0个月,P=0.007;30.0个月vs18.0个月,P=0.004)。多因素分析显示:ECOG评分是影响PFS及OS的独立影响因素。结论 (1)对于EGFR敏感突变或突变优势的Ⅳ期NSCLC患者,二线及二线以上使用EGFR-TKI可获益,疗效与一线EGFR-TKI治疗相近;(2)ECOG评分是影响PFS及OS的独立影响因素,ECOG评分0,1分的患者及未吸烟的患者有较好的ORR率,二线与二线以上EGFR-TKI疗效无明显差别;(3)EGFR 19del组与L858R组相比,近期有效率及OS无明显差别,但19del组PFS更长。     

盐酸埃克替尼治疗晚期肺腺癌的回顾性研究

目的:探讨盐酸埃克替尼治疗晚期肺腺癌的有效性和安全性。方法:利用我院肿瘤患者数据库,回顾性筛选2012年1月–2014年1月于本中心接受盐酸埃克替尼治疗的晚期肺腺癌患者,对符合纳入标准的患者采集年龄、性别、PS评分、肿瘤分期、分子病理改变、用药情况、不良反应等相关临床资料,并对患者进行生存随访。结果:本研究共纳入42例患者,共27例患者接受了EGFR突变基因检测,其中EGFR突变阳性21例。近期疗效方面,RR为38.1%(16/42);DCR为73.8%(31/42)。中位随访时间为15个月,全组人群中位PFS为14.5个月(95%CI:12.4–16.6个月)。单因素分析显示PFS与年龄、PS评分、治疗前CEA水平、是否放疗、是否脑转移无关(P>0.05),而与性别、吸烟状况、EGFR基因突变状况有关。常见的不良反应为皮疹和恶心呕吐,大部分为Ⅰ~Ⅱ度。结论:盐酸埃克替尼治疗晚期肺腺癌临床效果显著,耐受性好,可作为EGFR敏感突变的新选择。     

贝伐珠单抗联合放疗治疗EGFR野生型肺腺癌脑转移的临床研究

目的 探究贝伐珠单抗联合放疗治疗表皮生长因子受体（EGFR）野生型肺腺癌脑转移的临床效果。方法 于2020年5月至2022年5月采用随机数字表法将40例EGFR野生型肺腺癌脑转移患者分为参照组（全脑放疗+瘤区推量调强放疗）和试验组（贝伐珠单抗联合全脑放疗+瘤区推量调强放疗）各20例,对干预效果进行分析比较。结果 与参照组20.00%相比,试验组50.00%治疗总有效率显著更高（P <0.05）,治疗前研究对象的Karnofsky(KPS)评分、美国国立卫生研究院卒中量表（NIH Stroke Scale,NIHSS评分）、格拉斯哥昏迷计分（Glasgow Coma Scale,GCS）评分水平对比无显著差异（P> 0.05）,治疗后试验组KPS评分、GCS评分高于参照组,NIHSS评分低于参照组（P <0.05）;在不良事件发生率上,参照组40.00%与试验组50.00%相比无显著差异（P> 0.05）;试验组无进展生存时间（PFS）、总生存期（OS）显著高于参照组（P <0.05）。结论 将贝伐珠单抗联合放射治疗应用于EGFR野生型肺腺癌脑转移患者可显著...     

非小细胞肺癌脑转移的靶向治疗进展

非小细胞肺癌(NSCLC)脑转移患者预后差,自然中位生存期短。靶向药物的应用可使NSCLC脑转移患者的生存期显著延长。目前已发现的驱动基因中,表皮生长因子受体(EGFR)基因突变的占比最大,间变性淋巴瘤激酶(ALK)融合基因重排的脑转移发生率最高。针对上述2种基因的靶向药物不断被研发,美国国立癌症综合网络(NCCN)指南也推荐了不同的靶向治疗方案。本文结合NCCN指南,综述靶点为EGFR突变和ALK重排的靶向药物研究现状,聚焦药物颅内效应,旨在为上述2种驱动基因阳性的NSCLC脑转移患者的靶向治疗提供用药参考。     

表皮生长因子受体野生型肺腺癌脑转移的预后分析

目的分析表皮生长因子受体(EGFR)野生型肺腺癌脑转移的预后因素,探讨全脑放疗(WBRT)的必要性。方法分析我院2010年8月至2014年8月经过EGFR基因突变检测的EGFR野生型肺腺癌脑转移患者177例,采用Kaplan-Meier法进行生存分析,Logrank检验对不同亚组间生存曲线进行比较,Cox模型进行多因素预后分析。结果中位生存期为7.5个月,单因素分析显示性别(P=0.046)、年龄(P=0.055)、KPS评分(P<0.01)、原发灶控制情况(P=0.097)、颅外转移情况(P=0.089)、全脑放疗(WBRT)(P=0.021)与预后有关;Cox回归分析显示:KPS评分(P<0.01)和WBRT(P<0.01)为EGFR野生型肺腺癌脑转移患者的独立预后因素。结论EGFR野生型肺腺癌脑转移患者预后因素主要为KPS评分和WBRT,WBRT对此类型脑转移患者治疗有益。     

TKI联合重组人血管内皮抑制素在TKI治疗后局部进展晚期肺腺癌患者的疗效

目的 探讨酪氨酸激酶抑制剂(TKI)联合重组人血管骨皮抑制素(恩度)在TKI治疗后出现局部进展的晚期肺腺癌患者中的临床疗效.方法 选取2018年1月至2019年8月收治的TKI治疗后出现局部进展的晚期肺腺癌患者18例,给予TKI联合恩度治疗,同时给予局部放疗,观察其治疗效果及不良反应情况.结果 全组18例患者中位PFS...     

奥希替尼联合卡铂致血小板减少1例

1病例资料患者,男,66岁。身高175 cm,体重83 kg;因"确诊左肺腺癌9月余,拟行第4周期化疗"入院。患者9个月前经肺穿刺活检诊断左肺腺癌(伴多发颅内转移)。病理提示:表皮生长因子受体(EGFR)基因第19外显子存在点突变。于2018年6月开始甲磺酸奥希替尼片(阿斯利康制药有限公司,规格:80 mg/片,批号不详)80 mg,po,qd靶向治疗。靶向治疗6月余,随访血常规等指标基本正常,但病灶较前增大,评估后调整治疗方案为继续靶向治疗(奥希替尼80 mg,po,qd),同时联合化疗(PP方案,三周方案)。     

EGFR基因突变状态与晚期肺腺癌一线化疗疗效的相关性

目的探讨EGFR基因突变与晚期肺腺癌患者一线化疗疗效的相关性。方法回顾性分析103例接受培美曲塞联合铂类(顺铂或者卡铂)方案一线化疗的Ⅲb期/Ⅳ期肺腺癌患者,根据EGFR基因突变状态分析临床特征与化疗疗效的关系。结果在全部103例患者中,EGFR突变型36例(35.0%),野生型67例(65.0%)。患者一线均接受培美曲塞联合铂类方案化疗,客观缓解率(Objective response rate,ORR)为27.2%,疾病控制率(Disease control rate,DCR)为71.8%。EGFR突变患者的DCR显著高于野生型患者(86.1%vs.64.2%,P=0.018)。所有患者的中位无进展生存时间(Progression free survival,PFS)为6个月,其中EGFR突变型患者PFS(8个月)优于野生型患者(5个月),差异有统计学意义(P=0.004)。Cox多因素分析显示,EGFR突变是影响PFS的独立预测因素(HR=0.684,95%CI:0.541~0.865,P=0.002)。结论 EGFR突变型患者一线接受培美曲塞联合铂类方案化疗,DCR和PFS均显著优于野生型患者。EGFR突变对晚期肺腺癌患者一线化疗PFS有预测意义。     

某市蒙古族与汉族肺腺癌EGFR基因突变的分析

目的研究内蒙古包头市蒙古族肺腺癌EGFR突变与汉族肺腺癌EGFR突变表达是否存在差异。方法收集临床肺腺癌患者石蜡包埋组织标本108例,包括53例蒙古族和55例汉族肺腺癌的样本,采用ARMS(amplification refractory mutation system,ARMS)PCR扩增方法检测非小细胞肺癌EGFR基因外显子18、19、20及21的突变,χ2析对比内蒙古地区蒙古族和汉族肺腺癌EGFR基因突变差异。结果108例肺腺癌患者中有46例EGFR基因突变,总突变率为42.59%,其中蒙古族突变22例,突变率为41.51%,汉族突变24例,突变率为43.64%,内蒙古包头市蒙古族肺腺癌EGFR突变率与汉族肺腺癌EGFR突变率比较无明显差异(P<0.001),突变以外显子19核苷酸缺失起始位2 235为主要突变点。结论内蒙古包头市蒙古族中肺腺癌EGFR基因突变率为41.51%,汉族中EGFR基因突变率为43.64%,内蒙古包头市蒙古族肺腺癌EGFR突变率与汉族肺腺癌EGFR突变率比较无明显差异,都适宜靶向药物治疗。     

吉非替尼治疗老年非小细胞肺癌化疗后脑转移的效果分析

目的 研究探讨吉非替尼治疗老年非小细胞肺癌化疗后脑转移的效果及安全性.方法 选择本院2009年6月至2012年6月收治的年龄≥60岁的非小细胞肺癌伴脑转移患者42例,均应用吉非替尼治疗,观察颅内外病灶的近期疗效及远期疗效(疾病进展时间TTP曲线及总生存时间OS曲线),并分析不同临床病理参数下中位TTP和中位OS,以评价吉非替尼治疗的控制效果.结果 42例患者颅内病灶RR率为33.3％,DCR率为97.6％;颅外病灶RR率为31.0％,DCR率为92.9％.42例患者中,有4例患者未进展,38例进展,平均中位TTP为245 d;截止到随访终止日或死亡日期,4例存活,38例死亡,平均中位OS为590 d,1年内生存率为76.2％(32/42),2年内生存率为11.9％(5/42).经统计,不同年龄段、性别、吸烟史、发生脑转移的时间、脑转移灶数目、吉非替尼治疗时机、放疗时间方面,均为影响TTP和OS的独立危险因素.结论 吉非替尼治疗老年非小细胞肺癌化疗后脑转移的效果值得肯定,安全性较好,其中以单发脑转移、一线治疗时机、同步放疗等患者应用吉非替尼治疗控制效果更好.     

非小细胞肺癌全脑放疗复发后替莫唑胺联合立体定向放疗补救治疗临床观察

目的评价非小细胞肺癌(NSCLC)全脑放疗后颅内失败采用替莫唑胺联合立体定向治疗挽救的价值。方法 54例患者进入本次研究,所有全脑放疗后颅内复发转移的患者接受替莫唑胺化疗联合立体定向放疗,分析局控率,生存率情况,多因素分析确定和生存相关的预后因素。结果随访率100%,中位随访时间为13个月。全组中位生存时间为11.7个月。独立递归分级指数(RPA)1,2,3级中位生存期分别为19,14,9个月。自脑转移开始患者的中位生存时间为15个月(6～22个月),立体定向治疗加替莫唑胺挽救治疗后6和12个月局部控制率分别为93%和65%。结论联合治疗有较好的有效性和安全性,值得在NSCLC中颅内治疗失败后作为挽救治疗推广。     

EGFR-TKI耐药后继续应用原TKI联合化疗与单纯化疗疗效比较

目的:研究表皮生长因子受体-酪氨酸酶抑制剂(EGFR-TKI)治疗中晚期肺癌发生耐药后行原TKI联合化疗较单纯化疗有无生存获益。方法:回顾性分析一线化疗联合第一代EGFR-TKI治疗中晚期肺癌发生耐药65例,按照后续治疗方案的不同分为单纯组(单纯培美曲塞化疗)35例和联合组(原TKI联合培美曲塞化疗)30例,比较两组疾病控制率(DCR)、无进展生存期(PFS)及和总生存期(OS)。结果:DCR单纯组51.43%,显著低于联合组的80.00%(P<0.05);中位FPS单纯组6.0个月,显著低于联合组的8.0个月(P<0.05);中位OS单纯组8.0个月,显著低于联合组的10.0个月(P<0.05)。结论:在耐药后使用原TKI联合培美曲塞化疗疗效优于单纯应用培美曲塞化疗,且在Ⅳ期肺癌患者中效果更好,而不良反应可耐受。     

Role of EGFR inhibitors in the treatment of central nervous system metastases from non-small cell lung cancer

Brain metastases (BM) are a common occurrence in patients with non-small cell lung cancer (NSCLC). Standard therapy options include whole brain radiotherapy and, in selected patients, surgery or stereotactic radiosurgery. The role of systemic treatment is controversial. There is a strong clinical rationale for the use of targeted therapies, because patients often have a poor performance status, and are not candidates for cytotoxic chemotherapy or radiotherapy, yet treatment is required to improve the extra-cranial disease. The efficacy of epidermal growth factor receptor (EGFR) inhibitors in the treatment of patients with BM from NSCLC has been reported mainly in case reports or small retrospective case series, with only a few prospective trials. Current evidence suggests that the use of EGFR tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib should be considered in patients with asymptomatic CNS involvement, when clinical characteristics suggest a high likelihood of response; these characteristics are adenocarcinoma histology, never-smoker status, female gender and East Asian ethnicity. Upfront therapy with EGFR TKIs should be strongly considered in asymptomatic patients harboring activating EGFR mutations. In symptomatic BM, radiotherapy (RT) remains the standard treatment. Based on currently available data, treatment with concurrent RT and EGFR TKIs should be investigated in experimental trials only.     

Real-world use of osimertinib in non–small cell lung cancer: ASTRIS study Korean subgroup analysis

Abstract

Objective: ASTRIS is a large real-world, open-label, multinational clinical study of osimertinib in patients with epidermal growth factor receptor (EGFR) T790M mutation-positive advanced non-small cell lung cancer (NSCLC) who have previously received a tyrosine kinase inhibitor (TKI). We report data from the Korean ASTRIS subgroup.

Methods: Adult patients with locally advanced or metastatic NSCLC with a confirmed T790M mutation, WHO performance status of 0–2 and prior EGFR-TKI therapy, received osimertinib 80?mg once daily. Efficacy outcomes were overall survival (OS), investigator-assessed response rate (RR) and progression-free survival (PFS), and time to treatment discontinuation (TTD).

Results: At data cut-off (20 October 2017), 466 Korean patients were enrolled. Baseline EGFR molecular testing was mainly performed on biopsied tissue (75.1%). Baseline mutations co-occurring with T790M included exon 19 deletions (60.7%) and L858R (32.8%). 1-year OS was 82.7% (OS data not matured at data cut-off). Overall, RR was 71.0%, median PFS was 12.4?months and median TTD was 15.0?months. In patients with/without CNS metastases, RR was 68.0% and 79.6%, respectively; median PFS, 10.8 and 11.0?months, respectively; and median TTD, 11.2 and 14.7?months, respectively. Overall, 31.1% of patients experienced ≥1 adverse event (AE), leading to dose modification (12.0%), discontinuation (5.2%) or death (2.8%). Serious AEs (24.9%) included pulmonary embolism (1.7%), pleural effusion (1.7%), and pneumonia (1.5%).

Conclusion: In this real-world subgroup analysis of Korean patients in the ASTRIS study, osimertinib demonstrated comparable clinical efficacy to that attained in the global ASTRIS study and other clinical trials, with no new safety concerns.     

扶正化痰方联合EGFR-TKI治疗晚期肺腺癌的疗效研究

目的分析扶正化痰方联合表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)对晚期EGFR敏感突变肺腺癌患者的疗效, 探讨扶正化痰方的增效减毒作用, 评估该药对患者预后的影响。方法选择济宁市第一人民医院自2017年7月至2019年12月初始治疗的ⅢB期或Ⅳ期肺腺癌伴EGFR敏感突变患者78例(治疗组40例、对照组38例)。其中男36例, 女42例, 年龄(60.65±12.12)岁, 治疗前卡式功能状态量表(KPS)评分(63.84±15.30)分。治疗方案:对照组给予EGFR-TKI靶向药物治疗;治疗组给予靶向治疗联合扶正化痰方。观察指标:比较两组客观缓解率(ORR)、无疾病进展生存期(PFS)、KPS评分、不良反应。采用独立样本t检验、χ2检验、Fisher确切概率法、Kaplan-Meier法。结果 (1)疗效:两组患者ORR、PFS差异均无统计学意义[82.50%(33/40)比81.57%(31/38), (10.86±2.60)个月比(10.08±1.56)个月](均P>0.05)。(2)不良反应:治疗组与对照组比较, 肝损害、皮疹、腹泻、间质性肺炎、口腔黏膜炎发生率...     

培美曲塞联合顺铂治疗晚期肺腺癌的临床分析

目的评价培美曲塞联合顺铂治疗晚期肺腺癌的疗效和毒副反应。方法 35例经病理或细胞学确诊的晚期肺腺癌初治患者,采用培美曲塞500mg/m2,第1天给药,并口服地塞米松、叶酸和肌内注射维生素B12预处理;顺铂75mg/m2,静滴,分2～4d给药,均予以保肝、护胃、止吐药物。治疗21d为1个周期,2个周期后评价疗效、毒副反应。结果 35例患者中,客观有效率为29%,疾病控制率为69%,PFS8个月(2～12个月),中位总生存期9个月(3～19个月)。毒副反应主要是骨髓抑制、胃肠道反应,均未达到Ⅲ～Ⅳ度。结论培美曲塞联合顺铂一线治疗晚期肺腺癌疗效较好,毒性反应轻,值得临床推广应用。     

Hypofractionated radiation therapy with versus without immune checkpoint inhibitors in patients with brain metastases: A meta-analysis

IntroductionThe efficacy and safety of hypofractionated radiation therapy (HFRT) combined with immune checkpoint inhibitors (ICIs) in patients with brain metastases (BM) remain controversial. This meta-analysis was performed to compare the efficacy and safety of HFRT with and without ICIs in BM patients.Materials and MethodsPubMed, Embase, and Cochrane Library were searched up to 25 December 2018 for studies that compared the efficacy and safety of HFRT with and without ICIs in BM patients.ResultsTwenty-four studies involving 2,365 patients were included in this analysis. Compared with those of HFRT without ICIs, the 6-month locoregional recurrence-free survival (LRFS) rate (P = 0.002), 6-month overall survival (OS) rate (P = 0.001), 1-year OS rate (P = 0.001), 2-year OS rate (P = 0.007), and median OS (mOS) (P < 0.001) were significantly improved in combined HFRT and ICI treatment. A trend toward improved 1-year LRFS rate (P = 0.392) and 3-year OS rate (P = 0.266) for the ICI arm was observed compared with the non-ICI arm, although there was no statistically significant difference between the two arms. No significant difference in toxicity was found between the two arms (radionecrosis: P = 0.361; BM hemorrhage: P = 0.738).ConclusionsCompared with HFRT without ICIs, the combination of these two therapies improved efficacy but did not increase toxicity in patients with BM.     

Comparative effectiveness of everolimus and axitinib as second targeted therapies for metastatic renal cell carcinoma in the US: a retrospective chart review

Background Second targeted therapies for metastatic renal cell carcinoma (mRCC) include mammalian target of rapamycin inhibitors (mTORis) and tyrosine kinase inhibitors (TKIs). This observational study compares overall survival (OS) and progression-free survival (PFS) of patients treated with everolimus (an mTORi) and axitinib (a TKI) following first TKI, and assesses the impact of type and duration of first TKI on the relative effectiveness of these second targeted therapies.

Methods Retrospective reviews of medical records were conducted by medical oncologists or hematologists/oncologists recruited from a nationwide panel. Included patients with mRCC were required to have discontinued a first TKI (sunitinib, sorafenib, or pazopanib) for medical reasons, and to have initiated everolimus or axitinib as second targeted therapy between February 2012 and January 2013. OS and PFS were compared between patients treated with everolimus vs. axitinib using multivariable Cox proportional hazards regression models. Comparative results were also stratified by type and duration of first TKI.

Results Included patients (n?=?325 for everolimus and n?=?127 for axitinib) had a mean age of 61 years and 31% were female. Sunitinib was the most commonly used first TKI (73%). After adjusting for patient characteristics, no statistically significant differences were observed in OS or PFS between everolimus and axitinib. When stratifying by type and duration of first TKI, there was no statistically significant difference in OS between everolimus and axitinib in all subgroups except for patients with?<6 months on sunitinib or sorafenib as first TKI. No significant difference in PFS was observed in any subgroup.

Limitations Important limitations include potential missing or inaccurate data in medical charts, and confounding due to unobserved factors.

Conclusions In this retrospective chart review, no significant differences were detected in OS or PFS between axitinib and everolimus as second targeted therapy. Longer duration of first TKI was not associated with increased effectiveness of subsequent axitinib compared to everolimus.     

吉非替尼与化疗用于晚期非小细胞肺癌维持治疗疗效的临床观察

目的 表皮生长因子受体酪氨酸激酶抑制剂(Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors,EGFR-TKIs)吉非替尼及细胞毒化疗药物如吉西他滨、培美曲塞均是晚期非小细胞肺癌(Non-Small Cell Lung Cancer,NSCLC)维持治疗的有效手段,为对比两类药物维持治疗的临床疗效,我们进行了本项研究.方法 回顾性分析接受吉非替尼、吉西他滨及培美曲塞维持治疗的65例晚期NSCLC,按照所接受的维持治疗方案种类分为吉非替尼维持治疗组和化疗维持治疗组,分析两组间疾病控制率、无进展生存(Progression-Free Survival,PFS)及总生存(Overall Survival,OS)的差异.结果 65例患者34例为吉非替尼维持治疗(10例已知为EGFR基因突变患者),31例为化疗维持治疗(21例为吉西他滨维持化疗,10例为培美曲塞维持化疗),两种维持治疗方案获得的疾病控制率(70.6％比64.5％,P=0.791)、PFS(6.4月比5.0月,P=0.110)、OS(16.3月比12.0月,P=0.327)比较差异无统计学意义.分层分析发现EGFR突变状态未知时,吉非替尼对比吉西他滨、培美曲塞维持治疗PFS(4.0月比4.0月比5.0月,P=0.462)、OS(14.4月比12.0月比12.2月,P=0.540)比较差异无统计学意义,然而吉非替尼维持治疗组EGFR突变阳性患者较突变状态未知患者PFS(11.2月比4.0月,P=0.001)、OS(31.9月比14.4月,P=0.02)显著延长,差异有统计学意义.结论 晚期NSCLC吉非替尼与化疗维持治疗疗效相似.吉非替尼维持治疗EGFR突变阳性患者较未知患者有明显获益,建议晚期NSCLC予吉非替尼维持治疗时常规行EGFR突变检测.