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目的研究晚期脊索瘤患者口服伊马替尼治疗的临床疗效分析。方法本研究收集2007年6月至2012年6月,在解放军总医院第一附属医院住院治疗的晚期脊索瘤患者63例,其中失访病例24例,我们长期追踪到的39例为可评价患者。患者在接受伊马替尼治疗前通过病理组化检测PDGFRβ蛋白表达情况,分为低表达组和高表达组。所有患者均口服伊马替尼的剂量为每天400 mg,每3个月进行1次CT或MRI检查肿瘤生长情况,按照RECIST标准评价临床治疗效果,同时比较两组患者对伊马替尼治疗疗效的差别,并以SPSS13.0作统计分析,P<0.05具有统计学意义;采用Kaplan-Meier法绘制患者生存曲线。结果免疫组化提示高表达PDGFRβ患者为25例,占64.1%,14例低表达患者,占35.9%;在39例可评价患者中,完全缓解(CR)病例为O例(O%),部分缓解(PR)病例为3例(8%),病情稳定(SD)患者为27例(69%),疾病进展(PD)病例为9例(23%);临床获益率为76.9%(CR%+PR%+SD%);中位无疾病进展期为9个月,中位生存时间为31.2个月。PDGFRp高表达组临床获益人数为22例(临床获益率88%),低表达组临床获益人数8例(临床获益率57.1%);两组患者相比差异有统计学意义,P值为0.0282。结论本研究提示伊马替尼在治疗晚期脊索瘤方面具有抗肿瘤活性,临床获益率较好,同时在PDGFRβ高表达的患者获得了更好的疗效。
Objective To study the clinical efficacy of oral imatinib in patients with advanced chordoma. Methods Sixty-three patients with advanced chordoma admitted to the First Affiliated Hospital of People’s Liberation Army General Hospital from June 2007 to June 2012 were enrolled. Among them, 24 cases were lost to follow-up. The 39 patients we traced for a long time were evaluable patients . Patients undergoing imatinib treatment before PDGFRβ protein expression by pathological examination, divided into low expression group and high expression group. All patients were given imatinib at a dose of 400 mg daily for CT or MRI examinations every three months. The clinical efficacy was evaluated according to RECIST criteria. The efficacy of imatinib was compared between the two groups The difference was statistically analyzed by SPSS 13.0, P <0.05 was statistically significant; Kaplan-Meier method was used to draw the survival curve. Results Immunohistochemistry showed that there were 25 cases (64.1%) with high expression of PDGFRβ and 14 cases (35.9%) with low expression. Among the 39 evaluable patients, 0 cases were complete remission (CR) 27 (69%) were in stable condition (SD) and 9 (23%) were in disease progression (PD); the rate of clinical benefit was 76.9% (CR) % + PR% + SD%). The median progression-free disease was 9 months and the median survival time was 31.2 months. The clinical benefit of PDGFRp overexpression group was 22 (clinical benefit rate was 88%), while the low expression group was 8 (clinical benefit rate was 57.1%). The difference between the two groups was statistically significant, P The value is 0.0282. Conclusions This study suggests that imatinib has antitumor activity in the treatment of advanced chordoma with good clinical benefit and better efficacy in patients with high expression of PDGFRβ.