Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Eur J Cardiothorac Surg. 2012 Nov;42(5):e96-101. doi: 10.1093/ejcts/ezs466. Epub 2012 Aug 19.
The study aimed to evaluate the prognostic significance of carcinoembryonic antigen levels in pleural lavage fluid (p-CEA) in patients with completely resected non-small-cell lung cancer (NSCLC).
We examined 72 patients who underwent curative surgical resections. Pleural lavage fluid was collected at thoracotomy before lung resection. Pleural lavage cytology and p-CEA were determined. The relationships between p-CEA and clinicopathological factors were analysed.
Four patients (5.6%) had positive pleural lavage cytologies. The median p-CEA was 65.2 ng/g protein (range, 0-7331.7). p-CEA was significantly correlated with pleural invasion and CEA levels in serum (s-CEA). Receiver operating characteristic curve analysis identified an optimal cut-off of 38 ng/g protein for p-CEA for predicting recurrence [area under the curve (AUC) = 0.669; sensitivity = 91.7%; specificity = 43.7%; 95% confidence interval (CI) = 0.541-0.796; P = 0.020], whereas this could not be identified for s-CEA (AUC = 0.535; 95% CI = 0.392-0.678; P = 0.629). With a mean follow-up period of 57.5 months, 5-year disease-free survival (DFS) rates were 86.5% for p-CEA ≤ 38 ng/g protein and 47.7% for p-CEA >38 ng/g protein (P = 0.0013). Even for patients with Stage I lung cancer, 5-year DFS rates were 88.2 and 53.8%, respectively (P = 0.017). Multivariate Cox analysis revealed that p-CEA was a significant independent factor for DFS and overall survival.
Intraoperative p-CEA may be a more powerful prognostic determinant than s-CEA for patients with NSCLC.
本研究旨在评估完全切除的非小细胞肺癌（NSCLC）患者胸腔灌洗液中癌胚抗原（CEA）水平（p-CEA）的预后意义。
我们检查了 72 例接受根治性手术切除的患者。在肺切除术前，通过胸腔切开术采集胸腔灌洗液。确定胸腔灌洗细胞学和 p-CEA。分析了 p-CEA 与临床病理因素之间的关系。
4 例（5.6%）胸腔灌洗液细胞学阳性。p-CEA 的中位数为 65.2ng/g 蛋白（范围 0-7331.7）。p-CEA 与胸膜侵犯和血清中 CEA 水平（s-CEA）显著相关。受试者工作特征曲线分析确定了 p-CEA 预测复发的最佳截断值为 38ng/g 蛋白（曲线下面积（AUC）=0.669；敏感性=91.7%；特异性=43.7%；95%置信区间（CI）=0.541-0.796；P=0.020），而 s-CEA 则无法确定（AUC=0.535；95%CI=0.392-0.678；P=0.629）。在平均随访 57.5 个月后，p-CEA ≤38ng/g 蛋白的 5 年无病生存率（DFS）为 86.5%，p-CEA ＞38ng/g 蛋白的 5 年 DFS 率为 47.7%（P=0.0013）。即使对于 I 期肺癌患者，5 年 DFS 率也分别为 88.2%和 53.8%（P=0.017）。多变量 Cox 分析显示，p-CEA 是 DFS 和总生存率的独立预后因素。
术中 p-CEA 可能是 NSCLC 患者比 s-CEA 更强大的预后预测因子。
