Yi Yan, Li Baosheng, Sun Hongfu, Zhang Zicheng, Gong Heyi, Li Hongsheng, Huang Wei, Wang Zhongtang
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China.
Tumour Biol. 2010 Aug;31(4):333-40. doi: 10.1007/s13277-010-0041-9. Epub 2010 May 20.
The purpose of this study was to investigate clinical-biological factors which could predict the sensitivity to chemoradiotherapy of esophageal squamous cell carcinoma (ESCC). One hundred eighty-one patients with stages I-IV ESCC were evaluated. The cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), carcinoembryonic antigen (CEA), albumin (A) as well as hemoglobin (HB) concentration were measured before the initiation of chemoradiotherapy (CRT). The cutoff values of CYFRA21-1, CEA, and A were defined as 3.4 ng/ml, 3.3 ng/ml, 3.5 g/dl, respectively. HB was divided into three levels: <12.0, 12.0-14.0, and >14.0 g/dl. Clinical factors such as sex, age, tumor location, primary cancer length, and tumor-node-metastasis stage were also evaluated. The effective rate (complete response + partial response) of the primary tumor estimated by computed tomography was 60.71% (17 out of 28) in patients with CEA high group while 92.54% (62 out of 67) in patients with CEA low group (P = 0.000) and 62.50% (20 out of 32) in patients with CYFRA21-1 high group while 92.98% (53 out of 57) in patients with CYFRA21-1 low group (P = 0.000). HB levels before and during CRT were also associated with the effectiveness (P = 0.005, 0.033, respectively). HB levels before CRT at 12.0-14.0 g/dl were associated with the best effectiveness, followed by >14.0 and <12.0 g/dl (effective rates 88.89% vs. 83.75%, 62.07%, respectively, P = 0.005). HB levels during CRT also showed similar results (effective rates 87.80% vs. 85.41%, 70.59%, respectively, P = 0.033). Furthermore, according to numbers of the above risk factors, the sensitivity of CRT was higher in patients with zero to one risk factors than those with two to four risk factors (P = 0.023). CYFRA21-1 and CEA as well as HB and their combination may be helpful in predicting the sensitivity to CRT of ESCC. However, the results should be further confirmed in larger, more homogeneous studies.
本研究的目的是调查可预测食管鳞状细胞癌（ESCC）对放化疗敏感性的临床生物学因素。对181例I-IV期ESCC患者进行了评估。在放化疗（CRT）开始前，测量细胞角蛋白19片段抗原21-1（CYFRA21-1）、癌胚抗原（CEA）、白蛋白（A）以及血红蛋白（HB）浓度。CYFRA21-1、CEA和A的临界值分别定义为3.4 ng/ml、3.3 ng/ml、3.5 g/dl。HB分为三个水平：<12.0、12.0 - 14.0和>14.0 g/dl。还评估了性别、年龄、肿瘤位置、原发癌长度和肿瘤-淋巴结-转移分期等临床因素。通过计算机断层扫描估计的原发肿瘤有效率（完全缓解 + 部分缓解）在CEA高组患者中为60.71%（28例中的17例），而在CEA低组患者中为92.54%（67例中的62例）（P = 0.000）；在CYFRA21-1高组患者中为62.50%（32例中的20例），而在CYFRA21-1低组患者中为92.98%（57例中的53例）（P = 0.000）。CRT前和CRT期间的HB水平也与疗效相关（分别为P = 0.005、0.033）。CRT前HB水平在12.0 - 14.0 g/dl时疗效最佳，其次是>14.0 g/dl和<12.0 g/dl（有效率分别为88.89%对83.75%、62.07%，P = 0.005）。CRT期间的HB水平也显示出类似结果（有效率分别为87.80%对85.41%、70.59%，P = 0.033）。此外，根据上述风险因素的数量，零至一个风险因素的患者对CRT的敏感性高于有两个至四个风险因素的患者（P = 0.023）。CYFRA21-1和CEA以及HB及其组合可能有助于预测ESCC对CRT的敏感性。然而，结果应在更大、更同质的研究中进一步得到证实。
