基因检测指导的化疗与经验性化疗在晚期肺癌患者中的疗效和安全性差异分析

Efficacy and Safety of Genetic Testing-Guided Chemotherapy vs. Empiric Chemotherapy in Patients with Advanced Lung Cancer

摘要: 目的：本研究旨在探讨个体化精准治疗在晚期非小细胞肺癌患者化疗领域的应用。方法：选取2023年9月到2025年6月北华大学附属医院心胸血管外科收治的非小细胞肺癌患者30例作为研究对象。采用回顾性分析，将30例患者分为观察组(15例)和对照组(15例)。观察组患者对ERCC1、ERCC2、XRCC1、MTHFR和TYMS、GSTP1和RRM1基因进行检测后选择敏感药物进行化疗。对照组采用紫杉醇联合铂类进行化疗。比较两组患者化疗后，经CT图像测量所得肿瘤最大长径变化差异以及化疗相关不良反应。结果：观察组与对照组患者在第2周期化疗结束后同化疗前，经CT图像测量的肿瘤最大长径变化差值有统计学差异(P = 0.030)。观察组与对照组患者第4周期化疗结束后同第2周期化疗后，经CT图像测量的肿瘤最大长径变化差值有统计学差异(P = 0.014)。安全性分析表明，两组在血液学毒性、肝肾毒性和消化系统反应等方面未见显著差异(P > 0.05)。结论：观察组与对照组在第2周期、第4周期化疗后肿瘤大小变化有显著差异。观察组与对照组患者分别在第2周期化疗结束后同化疗前，第4周期化疗结束后同第2周期化疗后，经CT图像测量的肿瘤最大长径变化差值有统计学差异。安全性分析表明，两组在血液学毒性、肝肾毒性和消化系统反应等方面未见显著差异。基因检测指导化疗显著提高短期疗效。

Abstract: Objective: To explore the application of individualized precision therapy in chemotherapy for patients with advanced non-small cell lung cancer (NSCLC). Methods: A retrospective analysis was conducted on 30 NSCLC patients treated in the Department of Cardiothoracic and Vascular Surgery, Affiliated Hospital of Beihua University, from September 2023 to June 2025. Patients were assigned to an observation group (n = 15) and a control group (n = 15). The observation group underwent genetic testing for ERCC1, ERCC2, XRCC1, MTHFR, TYMS, GSTP1, and RRM1, and subsequently received chemotherapy regimens selected according to predicted drug sensitivity. The control group received paclitaxel combined with a platinum agent. The primary outcome was the change in the maximum long-axis tumor diameter on CT imaging after chemotherapy. Chemotherapy-related adverse events were also compared. Results: Relative to baseline, the between-group difference in the change of maximum long-axis tumor diameter at the end of cycle 2 was statistically significant (P = 0.030). From cycle 2 to the end of cycle 4, the between-group difference in the further change of tumor diameter remained significant (P = 0.014). Safety analyses showed no significant differences between groups in hematologic toxicity, hepatic/renal toxicity, or gastrointestinal reactions (all P > 0.05).Conclusions: Tumor size reduction differed significantly between the observation and control groups after cycles 2 and 4. Specifically, the changes from baseline to the end of cycle 2 and from cycle 2 to the end of cycle 4 were significantly different between groups. Safety profiles were comparable, with no significant differences in major toxicities. Genetic testing–guided chemotherapy significantly improves short-term efficacy.