Yoshimasu Tatsuya, Kokawa Yozo, Oura Shoji, Hirai Issei, Sasaki Rie, Tanino Hirokazu, Sakurai Teruhisa, Okamura Yoshitaka
Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama 641-8509, Japan.
Cancer Sci. 2003 Aug;94(8):741-4. doi: 10.1111/j.1349-7006.2003.tb01512.x.
We investigated whether the early postoperative time course of carcinoembryonic antigen (CEA) level after resection of lung cancer could be used to predict patients' prognosis. Fifty-three lung cancer patients were included in this study. Postoperative serum CEA levels were calculated by means of non-linear least-squares fitting to the equation C(t) = (C(0)-C(p))exp(-kt) + C(p), where C(t) is postoperative CEA level, t is days after surgery, C(0) is CEA level at postoperative time 0, C(p) is CEA level at plateau, and k is the rate constant of elimination. Postoperative CEA production (P(p)) was calculated as C(p) multiplied by k. C(p) and P(p) represent the numbers of residual tumor cells after surgery. More residual tumor cells yield higher values of C(p) and P(p), and result in earlier recurrence.
Kinetic parameters could be obtained for 30 patients whose preoperative CEA levels were sufficiently elevated. Cutoff levels as predictors for recurrence were 1.1 ng/ml for C(p) and 0.9 ng/ml/day for P(p). The accuracy of prediction of recurrence using these cutoff levels was 79% with C(p) and 89% with P(p). A very poor prognosis was observed for patients with P(p) over 0.9 ng/ml/day.
Analysis of the time course of changes in CEA levels after resection of lung cancer appears to be useful for predicting patient prognosis. C(p) and P(p) are very precise predictors of recurrence.
我们研究了肺癌切除术后癌胚抗原（CEA）水平的早期术后时间进程是否可用于预测患者预后。本研究纳入了53例肺癌患者。术后血清CEA水平通过非线性最小二乘法拟合方程C(t) = (C(0)-C(p))exp(-kt) + C(p)计算得出，其中C(t)为术后CEA水平，t为术后天数，C(0)为术后时间0时的CEA水平，C(p)为平台期CEA水平，k为消除速率常数。术后CEA产生量（P(p)）计算为C(p)乘以k。C(p)和P(p)代表术后残留肿瘤细胞数量。残留肿瘤细胞越多，C(p)和P(p)值越高，导致复发越早。
对于术前CEA水平充分升高的30例患者可获得动力学参数。作为复发预测指标的临界值，C(p)为1.1 ng/ml，P(p)为0.9 ng/ml/天。使用这些临界值预测复发的准确率，C(p)为79%，P(p)为89%。观察到P(p)超过0.9 ng/ml/天的患者预后非常差。
肺癌切除术后CEA水平变化的时间进程分析似乎有助于预测患者预后。C(p)和P(p)是复发的非常精确的预测指标。
