Mu Xinlin, Gao Zhancheng, Ye Ruanjian
Department of Respiratory Medicine, Peking University People's Hospital, Beijng 100044, China.
Zhongguo Fei Ai Za Zhi. 2009 Sep 20;12(9):1051-4. doi: 10.3779/j.issn.1009-3419.2009.09.020.
Serum levels of tumor markers are associated with tumor metabolism or apoptosis, changes of which after chemotherapy may reflect tumor response to treatment. The aim of this study was to assess the predictive role of changes in serum levels of carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA 21-1) during chemotherapy in patients with advanced non-small cell lung cancer.
Changes in serum levels of CEA and CYFRA 21-1 were investigated retrospectively after one cycle of chemotherapy in 42 patients with advanced NSCLC. Correlations between the changes and radiological objective response were analyzed.
After two cycles of chemotherapy, radiological objective response rate was 28.6%. At baseline, gender, age, clinical stage, serum levels of CEA and CYFRA 21-1 were not different between patients with objective response (OR) and no response (NR). After one cycle of chemotherapy, compared to baseline level, declines in serum levels of CEA and CYFRA 21-1 were observed in patients with OR, but have no statistical significance. In contrast, reduction of CEA and CYFRA 21-1 over baseline after one cycle of chemotherapy showed statistically significant difference between OR and NR. When reduction percentages of CEA and CYFRA 21-1 were used to predict objective response of chemotherapy, the area under the ROC curve (AUC) was 0.875 for CEA and 0.919 for CYFRA 21-1. According to the ROC curve, a 22% reduction of CEA yielded a sensitivity of 58.3% and a specificity of 97%, 51% reduction of CYFRA 21-1 with a sensitivity of 83.3% and a specificity of 93.3%. When above reduction percentages were used as cutoffs for prediction of radiological objective response, combination of the CEA and CYFRA 21-1 yielded a sensitivity of 91.7% and a specificity of 86.7%.
Reduction percentages of CEA and CYFRA 21-1 during chemotherapy could be used to evaluate chemotherapy efficacy in patients with advanced NSCLC. The cutoffs of reduction percentage need further research.
血清肿瘤标志物水平与肿瘤代谢或凋亡相关，化疗后其变化可能反映肿瘤对治疗的反应。本研究旨在评估晚期非小细胞肺癌患者化疗期间癌胚抗原（CEA）和细胞角蛋白19片段（CYFRA 21-1）血清水平变化的预测作用。
回顾性研究42例晚期非小细胞肺癌患者化疗一个周期后CEA和CYFRA 21-1血清水平的变化。分析这些变化与影像学客观反应之间的相关性。
化疗两个周期后，影像学客观反应率为28.6%。基线时，有客观反应（OR）和无反应（NR）的患者在性别、年龄、临床分期、CEA和CYFRA 21-1血清水平方面无差异。化疗一个周期后，与基线水平相比，OR患者的CEA和CYFRA 21-1血清水平下降，但无统计学意义。相比之下，化疗一个周期后CEA和CYFRA 21-1较基线水平的降低在OR和NR患者之间具有统计学显著差异。当用CEA和CYFRA 21-1的降低百分比来预测化疗的客观反应时，CEA的ROC曲线下面积（AUC）为0.875，CYFRA 21-1为0.919。根据ROC曲线，CEA降低22%时，敏感性为58.3%，特异性为97%；CYFRA 21-1降低51%时，敏感性为83.3%，特异性为93.3%。当以上降低百分比用作预测影像学客观反应的临界值时，CEA和CYFRA 21-1联合使用时，敏感性为91.7%，特异性为86.7%。
化疗期间CEA和CYFRA 21-1的降低百分比可用于评估晚期非小细胞肺癌患者的化疗疗效。降低百分比的临界值需要进一步研究。
