Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Yahatanishi, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu 807, Japan.
Lung Cancer. 2011 Oct;74(1):112-7. doi: 10.1016/j.lungcan.2011.02.001. Epub 2011 Mar 12.
This study investigated the preoperative serum levels of CYFRA 21-1 and CEA as prognostic factors in patients with stage I non-small cell lung cancer.
This study evaluated 341 patients who had undergone a complete resection for stage I NSCLC between 2002 and 2008.
The patients included 193 males and 148 females. The mean age of the patients was 69.2 years (range: 19-88). The histological types included 264 adenocarcinomas, 56 squamous cell carcinomas, 11 large cell carcinomas, and 10 other types of carcinoma. A pneumonectomy was performed in 2 patients, a bilobectomy in 7, a lobectomy in 255, a segmentectomy in 46, and partial resection of the lung in 31 patients. The positive rates for CYFRA 21-1 in the adenocarcinoma and squamous cell carcinoma patients were 33.3% and 76.8%, respectively. The positive rates for CEA in adenocarcinoma and squamous cell carcinoma patients were 23.8% and 26.8%, respectively. The 5-year survival rate after surgery in the normal CYFRA 21-1 group and the high CYFRA 21-1 groups were 92.8% and 75.4%, respectively, in the patients with stage I NSCLC. There was a significant difference between the 2 groups (p<0.0001). The 5-year survival rate according to the serum level of CEA in the patients with stage I NSCLC were 88.3% for the normal group and 76.3% for the high group. In a multivariate analysis using the variables found to be significant prognostic factors in univariate analysis, a high CYFRA 21-1 level was found to be a significant independent prognostic factor (95% confidence interval 1.213-5.442, p=0.014).
A high preoperative CYFRA 21-1 level was a significant independent prognostic factor in patients with stage I NSCLC. The patients with a high CYFRA 21-1 level should carefully followed-up to rule out occult metastasis. Further clinical studies will be necessary to evaluate the efficacy of adjuvant therapy for the patients selected according to this criterion.
本研究旨在探讨术前血清 CYFRA 21-1 和 CEA 水平作为Ⅰ期非小细胞肺癌患者的预后因素。
本研究评估了 2002 年至 2008 年间接受完全切除术的 341 例Ⅰ期非小细胞肺癌患者。
患者包括 193 名男性和 148 名女性。患者的平均年龄为 69.2 岁（范围：19-88 岁）。组织学类型包括 264 例腺癌、56 例鳞状细胞癌、11 例大细胞癌和 10 例其他类型的癌。2 例患者行全肺切除术，7 例行双肺叶切除术，255 例行肺叶切除术，46 例行肺段切除术，31 例行肺部分切除术。腺癌和鳞状细胞癌患者中 CYFRA 21-1 的阳性率分别为 33.3%和 76.8%。腺癌和鳞状细胞癌患者中 CEA 的阳性率分别为 23.8%和 26.8%。Ⅰ期非小细胞肺癌患者术后 CYFRA 21-1 正常组和高 CYFRA 21-1 组的 5 年生存率分别为 92.8%和 75.4%，两组间差异有统计学意义（p<0.0001）。根据Ⅰ期非小细胞肺癌患者血清 CEA 水平，正常组和高组的 5 年生存率分别为 88.3%和 76.3%。多变量分析显示，术前高 CYFRA 21-1 水平是独立的预后因素（95%置信区间 1.213-5.442，p=0.014）。
术前高 CYFRA 21-1 水平是Ⅰ期非小细胞肺癌患者的独立预后因素。CYFRA 21-1 水平高的患者应密切随访以排除隐匿性转移。进一步的临床研究将有必要评估根据这一标准选择的患者辅助治疗的疗效。
