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目的旨在探讨载脂蛋白E(APOE)基因多态性、体重指数(BMI)对肾癌靶向治疗疗效和预后的影响。方法 80例接受索拉非尼或舒尼替尼单药治疗的晚期肾癌患者,治疗前进行rs8106822和rs405509基因多态性检测,收集BMI等临床资料,并观察无进展生存期(PFS)、总生存期(OS)及客观有效率(RR)。结果 77例患者测序成功,中位随访时间为20个月。rs8106822杂合基因型(GA)患者接受靶向药物治疗的疾病控制率为94.7%,优于纯合基因型(GG+AA)患者的71.8%(P=0.01),但rs8106822各基因亚型组间的中位PFS无显著差异。rs405509各基因型与靶向药物疗效或PFS之间无相关性。根据BMI传统标准将患者分为正常体重组(<25kg/m2)、超重组(BMI 25～30kg/m2)和肥胖组(>30kg/m2),3组患者的PFS无明显差异;而按BMI分别为24kg/m2和26kg/m2将患者分为正常体重组(18～23.9kg/m2)、临界超重组(24～25.9kg/m2)和超重组(≥26kg/m2),其中超重组患者的PFS为14个月,显著长于临界超重组的8个月(P=0.04),但与正常体重组无差异。结论 APOE基因多态性、BMI可能与晚期肾癌患者靶向治疗的疗效相关。总生存结果有待于进一步随访。
Objective To investigate the effects of apolipoprotein E (APOE) gene polymorphism and body mass index (BMI) on the efficacy and prognosis of targeted therapy of renal cell carcinoma. Methods Eighty patients with advanced renal cell carcinoma who were treated with sorafenib or sunitinib monotherapy were tested for rs8106822 and rs405509 gene polymorphism before treatment and clinical data such as BMI were collected and the progression-free survival (PFS) Total survival (OS) and objective efficiency (RR). Results 77 patients were successfully sequenced. The median follow-up time was 20 months. Patients with rs8106822 heterozygous genotype (GA) had a disease control rate of 94.7% for targeted therapy compared with 71.8% for patients with homozygous genotype (GG + AA) (P = 0.01), but rs8106822 There was no significant difference between the median PFS. There was no correlation between rs405509 genotypes and the efficacy of targeted drugs or PFS. Patients were divided into normal weight group (<25kg / m2), overweight group (BMI 25 ~ 30kg / m2) and obese group (> 30kg / m2) according to the traditional BMI standards. There was no significant difference in PFS between the three groups Patients were divided into normal weight group (18 ~ 23.9kg / m2), critical overweight group (24 ~ 25.9kg / m2) and overweight group (≥26kg / m2) at 24kg / m2 and 26kg / PFS was 14 months, significantly longer than the critical overweight group of 8 months (P = 0.04), but no difference with the normal body weight group. Conclusion APOE gene polymorphism and BMI may be related to the curative effect of targeted therapy in patients with advanced renal cell carcinoma. The overall survival result needs to be followed up further.