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血液生物标志物检测对晚期非小细胞肺癌EGFR-TKI治疗疗效的评估价值

Evaluation Value of Blood Biomarker Tests for Efficacy of EGFR-TKI in Advanced NSCLC Treatment

  • 摘要:
    目的 分析接受一线EGFR-TKI治疗的非小细胞肺癌患者的外周血CTCs和ctDNA水平,探究CTCs和ctDNA检测对晚期肺癌疗效评估的临床价值。
    方法 纳入109例接受一线EGFR-TKI治疗的非小细胞肺癌患者,在基线和治疗1月后检测血清肿瘤指标CEA、CTCs和ctDNA水平,并行胸部CT检查,依据RECIST1.1标准评估疗效,CTCs通过富集-染色-计算算法分析恶性特征进行计数,ctDNA通过数字PCR进行。
    结果 基线时CEA、ctDNA检测异常和治疗后外周血CTCs降低的患者生存率更低。在SD亚组患者中,脑转移、晚期的患者PFS获益更低。
    结论 SD亚组患者的复发风险显著高于PR或CR组患者,因此,建议将CTCs和ctDNA检测应用于SD亚组患者中,以识别对EGFR-TKI治疗疗效不佳的高危患者,及时介入额外治疗干预以期获得更长的无进展生存期。

     

    Abstract:
    Objective To analyze the levels of serum CTCs and ctDNA in NSCLC patients receiving first-line EGFR-TKI treatment, and to explore the clinical value of CTCs and ctDNA detection in assessing the efficacy of treatment for advanced lung cancer.
    Methods A total of 109 NSCLC patients receiving first-line EGFR-TKI treatment were enrolled. Serum tumor markers CEA, CTCs, and ctDNA were detected at baseline and after one month of treatment. Chest CT scans were performed, and treatment efficacy was evaluated based on RECIST1.1 criteria. CTCs were counted by enrichment-staining-computational algorithm to analyze malignant features, while ctDNA was assessed using digital PCR.
    Results Survival rate was low in patients with abnormal CEA and ctDNA tests at baseline and in patients with reduced serum CTCs after treatment. In the SD subgroup of patients with brain metastases and advanced stage, the PFS benefit was low.
    Conclusion Patients in the SD subgroup have significantly higher recurrence risks than those in the PR or CR subgroups. Therefore, CTC and ctDNA testing should be applied to patients in the SD subgroup to identify high-risk patients with poor response to EGFR-TKI treatment, intervene with additional treatment promptly, and obtain long progression-free survival.

     

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