Correlation between Napsin A expression and the efficacy of second or later-line bevacizumab combined with chemotherapy in the treatment of advanced lung adenocarcinoma
Objective To investigate the correlation between Napsin A expression and the efficacy of second or later-line bevacizumab combined with chemotherapy in the treatment of advanced lung adenocarcinoma.Methods The clinical data of 103 patients with stage ⅢB-Ⅳ lung adenocarcinoma admitted to the 901st Hospital of the Joint Logistics Support Force of PLA from January 2018 to March 2022 were retrospectively analyzed.The expression of Napsin A protein was detected by the immunohistochemical EnVision method,and the mutations of epidermal growth factor receptor(EGFR),KRAS,and TP53 were detected by the amplification arrest mutation system(ARMS).The influencing factors of short-term efficacy,progression-free survival(PFS),and overall survival(OS)in patients with advanced lung adenocarcinoma treated with second or later-line bevacizumab combined with chemotherapy were analyzed.Follow-up was completed on December 31,2023.x2 test was used for comparison between groups.Kaplan-Meier method was used to plot the survival curve and Log-rank test was used for comparison between groups.Cox proportional hazards regression model was used for multivariate analysis.Results Among the 103 patients with advanced lung adenocarcinoma,there were 58 males and 45 females,with a median age of 63 years old,30 cases had a history of smoking,31 cases had brain metastases,and there were 67 cases of second-line treatment and 36 cases of third or later-line treatment.The chemotherapy regimens included pemetrexed and platinum in 73 cases,pemetrexed alone in 16 cases,docetaxel in 7 cases,and paclitaxel in 7 cases.The number of treatment cycles was ≥4 in 67 cases and＜4 in 36 cases.There were 12 cases of KRAS mutation(11.7％),18 cases of TP53 mutation(17.5％),and 50 cases of EGFR mutation(48.5％).There were 76 cases(73.8％)of Napsin A positive.The objective response rate(ORR)was 32.0％(33/103),and the disease control rate(DCR)was 79.6％(82/103);the DCR of Napsin A-negative patients was lower than that of Napsin A-positive patients(P＜0.001).The median PFS was 6.4 months(95％CI:5.9-6.9),and univariate analysis showed that the patients'PFS was related to the number of treatment lines(P=0.009),treatment cycle(P＜0.001),Napsin A expression(P＜0.001),KRAS mutation(P=0.012),and TP53 mutation(P=0.045).The median OS was 12.7 months(95％CI:10.5-14.9),and univariate analysis showed that the patients'OS was related to treatment cycle(P=0.020),KRAS mutation(P=0.046),and Napsin A expression(P=0.001).Multivariate Cox regression analysis showed that Napsin A positivity(P=0.020),number of treatment cycles ≥4(P=0.004),second-line treatment(P=0.009),and wild-type KRAS(P=0.012)were independent protective factors for PFS;Napsin A positivity(P=0.013)and wild-type KRAS(P=0.042)were independent protective factors for OS.Conclusion Patients with advanced lung adenocarcinoma receiving second or later-line bevacizumab combined with chemotherapy have definite efficacy,and Napsin A positive and wild-type KRAS patients have better prognosis.
万方数据
维普
