[摘要] 目的：探讨T790M突变的肺腺癌骨转移患者接受个体化综合治疗的疗效及预后的相关因素。方法：回顾性分析68例经个体化综合治疗的T790M突变的肺腺癌骨转移患者的临床资料，采取化疗、放疗、靶向分子药物、单抗类药物、双磷酸盐等综合治疗，观察疗效及预后，分析相关因素。结果：个体化综合治疗有效率为60.3%(41/68)，中位生存期为23 个月。无放疗、T790M耐药基因突变无合并KRAS耐药基因突变、既往化疗类型为辅助化疗、N1 期、孤立的骨转移灶、化疗交替奥希替尼治疗、转移器官个数少、以及ECOG评分<2 分对远期疗效有显著影响（P<0.05）。多因素分析显示，T790M耐药基因突变无合并KRAS耐药基因突变（P=0.012）、转移器官个数0 或1 个（P=0.000）、化疗有无交替奥希替尼（P=0.020）及孤立的骨转移灶为影响T790M突变的肺腺癌骨转移患者联合治疗后远期疗效的保护因素。结论：T790M耐药基因突变无合并KRAS耐药基因突变肺癌患者经化疗、靶向分子药物等综合治疗获得了较长的生存时间，化疗联合靶向分子药物、双磷酸盐类药物等综合治疗为T790M突变的肺腺癌骨转移患者提供了有潜力的治疗模式。

[Abstract] Objective: To explore the related factors for efficacy and prognosis of personalized comprehensive treatment for T790Mpositive lung adenocarcinoma patients with bone metastasis. Methods: The clinical data of 68 patients undergoing personalized comprehensive treatment for T790M-positive lung adenocarcinoma with bone metastasis were retrospectively reviewed; chemotherapy, radiotherapy,molecule-targeted agents, Bevacizumab, bisphosphonate and other therapies were chosen for the patients, and the efficacy and prognosis were observed to explore the related factors. Results: Effective rate of personalized comprehensive treatment was 60.3% (41/68), with a median survival time of 23 months. Multiple factors showed significant effects on long-term efficacy, such as no radiotherapy,T790M mutation but no KRAS mutation, adjuvant scheme+rescue scheme in prior chemotherapy treatment, N1 stage, isolated bone metastasis, alternative treatment of osimertinib with chemotherapy, less metastasized organs and ECOG scores<2 (P<0.05). Multivariate analysis revealed that T790M mutation but no KRAS mutation (P=0.012), number of metastasized organs =0 or 1 (P=0.000), alternative treatment of osimertinib with chemotherapy (P=0.020), and isolated bone metastasis (P=0.006) were independent protective factors for long-term results of personalized comprehensive treatment for T790M-positive lung adenocarcinoma patients with bone metastasis.Conclusion: Chemotherapy combined with osimertinib, agents of bisphosphonate and other personalized comprehensive treatment prolongs survival time in T790M-positive lung adenocarcinoma patients without KRAS mutation, providing a potential therapeutic model for those patients.

2018 年度海南省卫生计生行业科研项目（No. 18A200125）