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【medical-news】非小细胞肺癌术后顺铂辅助化疗的
Background Adjuvant cisplatin-based chemotherapy improves survival among patients with completely resected non–small-cell lung cancer, but there is no validated clinical or biologic predictor of the benefit of chemotherapy.
背景 以顺铂为基础的辅助化疗可以延长可手术切除的非小细胞肺癌患者的生存期，但是没有有效的临床或生物学指标可以预测这种优势。
Methods We used immunohistochemical analysis to determine the expression of the excision repair cross-complementation group 1 (ERCC1) protein in operative specimens of non–small-cell lung cancer. The patients had been enrolled in the International Adjuvant Lung Cancer Trial, thereby allowing a comparison of the effect of adjuvant cisplatin-based chemotherapy on survival, according to ERCC1 expression. Overall survival was analyzed with a Cox model adjusted for clinical and pathological factors.
方法 我们采用免疫组化的方法分析了非小细胞肺癌患者手术标本中切除修复交叉互补基因1（excision repair cross-complementation group 1 ，ERCC1）的表达。这些患者已经被纳入国际肺癌辅助治疗试验（International Adjuvant Lung Cancer Trial），从而可以根据ERCC1的表达来比较以顺铂为基础的辅助化疗对生存期的影响。采用Cox模型分析了总生存期，并且校正了临床和病理因素的影响。
Results Among 761 tumors, ERCC1 expression was positive in 335 (44%) and negative in 426 (56%). A benefit from cisplatin-based adjuvant chemotherapy was associated with the absence of ERCC1 (test for interaction, P=0.009). Adjuvant chemotherapy, as compared with observation, significantly prolonged survival among patients with ERCC1-negative tumors (adjusted hazard ratio for death, 0.65; 95% confidence interval [CI], 0.50 to 0.86; P=0.002) but not among patients with ERCC1-positive tumors (adjusted hazard ratio for death, 1.14; 95% CI, 0.84 to 1.55; P=0.40). Among patients who did not receive adjuvant chemotherapy, those with ERCC1-positive tumors survived longer than those with ERCC1-negative tumors (adjusted hazard ratio for death, 0.66; 95% CI, 0.49 to 0.90; P=0.009).
结果 在761例肿瘤中，335例（44%）表达ERCC1，而426例（56%）不表达。以顺铂为基础的辅助化疗的有效率和ERCC1的缺失相关（相互作用检验，P=0.009）。与对照组相比，辅助化疗可以明显延长ERCC1阴性患者的生存期（校正的死亡危险比，0.65；95%可信区间[CI]，0.50~0.86；P=0.002），但是不能延长ERCC1阳性患者的生存期（校正的死亡危险比，1.14；95%可信区间[CI]，0.84~1.55；P=0.40）。在没有接受辅助化疗的患者里，那些ERCC1阳性的患者生存期长于阴性患者（校正的死亡危险比，0.66；95%可信区间[CI]，0.49~0.90；P=0.009）。
Conclusions Patients with completely resected non–small-cell lung cancer and ERCC1-negative tumors appear to benefit from adjuvant cisplatin-based chemotherapy, whereas patients with ERCC1-positive tumors do not.
结论 可手术切除和ERCC1阴性的非小细胞肺癌患者可以从以顺铂为基础的辅助化疗中受益，但ERCC1阳性的患者却不能受益。
个人拙见：个体化治疗癌症已经成为目前治疗肿瘤的热点。但是如何个体化治疗，如何寻找具有预测价值的临床和分子生物学指标，成为摆在个体化治疗面前的一大难题！ERCC1基因在非小细胞肺癌治疗中的预测作用，无疑给我们带来了曙光！
来源：DNA Repair by ERCC1 in Non–Small-Cell Lung Cancer and
Cisplatin-Based Adjuvant Chemotherapy
N Engl J Med，355:983-991 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-01-11 05:14
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