[血清癌胚抗原在预测接受表皮生长因子受体酪氨酸激酶抑制剂治疗的晚期非小细胞肺癌患者化疗疗效及预后中的价值]

[Value of serum carcinoembryonic antigen in prediction of chemotherapy efficacy and prognosis in patients with advanced non-small cell lung cancer treated with EGFR-tyrosine kinase inhibitor].

作者信息

Xu Chong-an, Su He, Liu Jia-li, Li Lin, Zou Hua-wei

机构信息

Department of Medical Oncology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2011 Jun;33(6):436-41.

PMID:21875484

Abstract

OBJECTIVE

The aim of this study was to detect the pre- and post-treatment serum carcinoembryonic antigen (CEA) levels after 4 weeks of EGFR-TKIs treatment in advanced non-small cell lung cancer (NSCLC) patients to evaluate the clinical value of CEA in the prediction of chemotherapy response and prognosis in those patients.

METHODS

Pre- and post-treatment serum CEA levels of the patients were measured with immunoradiometric kits after 4 weeks of EGFR-TKIs treatment to evaluate the relationship between chemotherapy response and prognosis.

RESULTS

After 4 weeks of EGFR-TKIs treatment, one patient in the total of 75 patients (1.3%) achieved complete response (CR), 17 patients (22.7%) achieved partial response (PR), 31 patients (41.3%) achieved disease stable (SD) and 26 patients had progressive disease (PD). The radiological objective response rate(ORR) and disease control rate (DCR) were 24.0% and 65.3%, respectively. The median survival time (MST) of all patients was 8.1 months. The MST of SD patients was similar to that in the OR patients (P = 0.06), but both longer than that in the PD patients (P < 0.001). The MST of DC patients was similar to that in OR patients (P = 0.358), but longer than that in PD patients (P < 0.001). Serum CEA levels decreased ≥ 32% and ≥ 61% were closely related with the objective response and disease control. The median survival time (MST) of patients with serum CEA decreased ≥ 32% was longer than those with CEA decreased < 32% (9.5 months vs 6.7 months, P < 0.0001). The MST of patients with serum CEA decreased ≥ 32% was similar to those with CEA decreased ≥ 61% (9.5 months vs 10.5 months, P = 0.370), but both longer than those with CEA decreased < 32% (6.7 months, P < 0.001). Cox multivariate survival analysis confirmed that serum CEA level decreased ≥ 32%, CEA level decreased ≥ 61%, PS score, and DC are independent prognostic factor, but not OR.

CONCLUSIONS

To advanced NSCLC patients, the disease control rate (DCR) may be more suitable than objective response rate (ORR) as an indicator in predicting the efficacy and prognosis in advanced NSCLC patients. Serum CEA levels decreased ≥ 32% may be a reliable indicator to determine the therapeutic efficacy of EGFR-TKIs.

摘要

目的

本研究旨在检测晚期非小细胞肺癌（NSCLC）患者接受表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）治疗4周前后的血清癌胚抗原（CEA）水平，以评估CEA在预测这些患者化疗反应及预后方面的临床价值。

方法

采用免疫放射分析试剂盒检测患者接受EGFR-TKIs治疗4周前后的血清CEA水平，以评估化疗反应与预后之间的关系。

结果

EGFR-TKIs治疗4周后，75例患者中1例（1.3%）达到完全缓解（CR），17例（22.7%）达到部分缓解（PR），31例（41.3%）疾病稳定（SD），26例疾病进展（PD）。放射学客观缓解率（ORR）和疾病控制率（DCR）分别为24.0%和65.3%。所有患者的中位生存时间（MST）为8.1个月。SD患者的MST与部分缓解（PR）患者相似（P = 0.06），但均长于PD患者（P < 0.001）。疾病稳定（SD）患者的MST与部分缓解（PR）患者相似（P = 0.358），但长于PD患者（P < 0.001）。血清CEA水平下降≥32%和≥61%与客观缓解及疾病控制密切相关。血清CEA水平下降≥32%的患者中位生存时间长于CEA下降<32%的患者（9.5个月对6.7个月，P < 0.0001）。血清CEA水平下降≥32%的患者MST与CEA下降≥61%的患者相似（9.5个月对10.5个月，P = 0.370），但均长于CEA下降<32%的患者（6.7个月，P < 0.001）。Cox多因素生存分析证实，血清CEA水平下降≥32%、CEA水平下降≥61%、体力状况（PS）评分及疾病稳定（SD）是独立的预后因素，而非部分缓解（PR）。