化疗期间血清癌胚抗原和细胞角蛋白19片段水平下降可预测晚期非小细胞肺癌患者的客观缓解率和生存率。

Decline in serum carcinoembryonic antigen and cytokeratin 19 fragment during chemotherapy predicts objective response and survival in patients with advanced nonsmall cell lung cancer.

作者信息

Ardizzoni Andrea, Cafferata Mara A, Tiseo Marcello, Filiberti Rosangela, Marroni Paola, Grossi Francesco, Paganuzzi Michela

机构信息

Division of Medical Oncology, University Hospital of Parma, Parma, Italy.

出版信息

Cancer. 2006 Dec 15;107(12):2842-9. doi: 10.1002/cncr.22330.

DOI:10.1002/cncr.22330

PMID:17103443

Abstract

BACKGROUND

The authors assessed the predictive and prognostic role of decline in the serum levels of carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA 21-1) during chemotherapy in patients with advanced nonsmall cell lung cancer (NSCLC).

METHODS

Changes in serum levels of CEA and CYFRA 21-1 during first-line, conventional chemotherapy were studied prospectively with an immunometric assay at baseline and every 2 courses in 117 patients with advanced NSCLC. Data were correlated with radiologic objective response (OR) and survival.

RESULTS

One hundred seven patients were evaluable for radiologic and serologic response assessment after 2 chemotherapy courses. The radiologic OR rate was 44% overall. The CEA and CYFRA 21-1 responses (> or =20% reduction over baseline level; assessed after the second course of chemotherapy) were 38% and 61%, respectively. Statistically significant correlations were observed between CEA and CYFRA 21-1 responses and OR (P = .01 and P = .004, respectively). The median survival from response assessment (landmark analysis) was 9 months. In a univariate analysis, disease stage, performance status, baseline lactate dehydrogenase level (LDH), OR, CEA response, and CYFRA 21-1 response were correlated significantly with survival. In particular, the median survival was 13 months for patients who had a CEA response and 11 months for patients who had a CYFRA 21-1 response compared with 8 months and 6 months for patients who did not respond, respectively. In a multivariate analysis, performance status (P = .005), baseline LDH level (P = .02), CEA response (P = .03) and CYFRA 21-1 response (P = .01) were confirmed as independent prognostic factors for survival.

CONCLUSIONS

CEA and CYFRA 21-1 responses appeared to be reliable surrogate markers of chemotherapy efficacy in patients with advanced NSCLC.

摘要

背景

作者评估了晚期非小细胞肺癌（NSCLC）患者化疗期间癌胚抗原（CEA）和细胞角蛋白19片段（CYFRA 21-1）血清水平下降的预测和预后作用。

方法

采用免疫测定法对117例晚期NSCLC患者进行前瞻性研究，在基线及每2个疗程时检测一线常规化疗期间CEA和CYFRA 21-1的血清水平变化。数据与放射学客观缓解（OR）及生存情况相关。

结果

107例患者在2个化疗疗程后可进行放射学和血清学缓解评估。总体放射学OR率为44%。CEA和CYFRA 21-1缓解率（较基线水平降低≥20%；在第二个化疗疗程后评估）分别为38%和61%。CEA和CYFRA 21-1缓解与OR之间存在统计学显著相关性（分别为P = 0.01和P = 0.004）。自缓解评估（标志性分析）起的中位生存期为9个月。单因素分析中，疾病分期、体能状态、基线乳酸脱氢酶水平（LDH）、OR、CEA缓解及CYFRA 21-1缓解与生存显著相关。特别是，有CEA缓解的患者中位生存期为13个月，有CYFRA 21-1缓解的患者为11个月，而无缓解的患者分别为8个月和6个月。多因素分析中，体能状态（P = ＜0.005）、基线LDH水平（P = 0.02）、CEA缓解（P = 0.03）和CYFRA 21-1缓解（P = 0.01）被确认为生存的独立预后因素。