Arrieta Oscar, Saavedra-Perez David, Kuri Roberto, Aviles-Salas Alejandro, Martinez Luis, Mendoza-Posada Daniel, Castillo Patricia, Astorga Alma, Guzman Enrique, De la Garza Jaime
Department of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico.
BMC Cancer. 2009 Apr 22;9:119. doi: 10.1186/1471-2407-9-119.
Central nervous system is a common site of metastasis in NSCLC and confers worse prognosis and quality of life. The aim of this prospective study was to evaluate the prognostic significance of clinical-pathological factors (CPF), serum CEA levels, and EGFR and HER2 tissue-expression in brain metastasis (BM) and overall survival (OS) in patients with advanced NSCLC.
In a prospective manner, we studied 293 patients with NSCLC in IIIB-IV clinical stage. They received standard chemotherapy. CEA was measured prior to treatment; EGFR and HER2 were evaluated by immunohistochemistry. BM development was confirmed by MRI in symptomatic patients.
BM developed in 27, and 32% of patients at 1 and 2 years of diagnosis with adenocarcinoma (RR 5.2; 95% CI, 1.002-29; p = 0.05) and CEA > or = 40 ng/mL (RR 11.4; 95% CI, 1.7-74; p < 0.01) as independent associated factors. EGFR and HER2 were not statistically significant. Masculine gender (RR 1.4; 95% CI, 1.002-1.9; p = 0.048), poor performance status (RR 1.8; 95% CI, 1.5-2.3; p = 0.002), advanced clinical stage (RR 1.44; 95% CI, 1.02-2; p = 0.04), CEA > or = 40 ng/mL (RR 1.5; 95% CI, 1.09-2.2; p = 0.014) and EGFR expression (RR 1.6; 95% CI, 1.4-1.9; p = 0.012) were independent associated factors to worse OS.
High CEA serum level is a risk factor for BM development and is associated with poor prognosis in patients with advanced NSCLC. Surface expression of CEA in tumor cells could be the physiopathological mechanism for invasion to CNS.
中枢神经系统是非小细胞肺癌常见的转移部位，会导致更差的预后和生活质量。这项前瞻性研究的目的是评估临床病理因素（CPF）、血清癌胚抗原（CEA）水平以及表皮生长因子受体（EGFR）和人表皮生长因子受体2（HER2）组织表达在晚期非小细胞肺癌患者脑转移（BM）及总生存期（OS）方面的预后意义。
我们前瞻性地研究了293例处于IIIB-IV期临床阶段的非小细胞肺癌患者。他们接受了标准化化疗。在治疗前检测CEA；通过免疫组织化学评估EGFR和HER2。有症状患者通过磁共振成像（MRI）确诊脑转移。
27例患者发生脑转移，腺癌患者在诊断后1年和2年发生脑转移的比例分别为32%（相对危险度5.2；95%可信区间，1.002 - 29；p = 0.05），CEA≥40 ng/mL作为独立相关因素（相对危险度11.4；95%可信区间，1.7 - 74；p < 0.01）。EGFR和HER2无统计学意义。男性（相对危险度1.4；95%可信区间，1.002 - 1.9；p = 0.048）、较差的体能状态（相对危险度1.8；95%可信区间，1.5 - 2.3；p = 0.002）、晚期临床分期（相对危险度1.44；95%可信区间，1.02 - 2；p = 0.04）、CEA≥40 ng/mL（相对危险度1.5；95%可信区间，1.09 - 2.2；p = 0.014）以及EGFR表达（相对危险度1.6；95%可信区间，1.4 - 1.9；p = 0.012）是总生存期较差的独立相关因素。
高血清CEA水平是脑转移发生的危险因素，且与晚期非小细胞肺癌患者的不良预后相关。肿瘤细胞中CEA的表面表达可能是侵袭中枢神经系统的病理生理机制。
