血清CYFRA21-1和癌胚抗原水平下降作为晚期非小细胞肺癌患者化疗反应和生存的预测指标
Declines in serum CYFRA21-1 and carcinoembryonic antigen as predictors of chemotherapy response and survival in patients with advanced non-small cell lung cancer.
作者信息
Yang Liang, Chen Xin, Li Yue, Yang Jun, Tang Li
机构信息
Department of Echocardiography, The First Affiliated Hospital of China Medical University, Shenyang 110001;
出版信息
Exp Ther Med. 2012 Aug;4(2):243-248. doi: 10.3892/etm.2012.570. Epub 2010 May 10.
The aim of this study was to investigate the clinical value of serum cytokeratin 19 fragment (CYFRA21-1) and carcinoembryonic antigen (CEA) in the prediction of chemotherapy response and prognosis in patients with advanced non-small cell lung cancer (NSCLC). Serum CYFRA21-1 and CEA levels of 98 patients with advanced NSCLC were measured using immunoradiometric kits prior to and after 2 cycles of chemotherapy. After 2 cycles of chemotherapy, 45 patients achieved a radiological objective response (OR), 30 patients achieved stable disease (SD) and 23 patients had progressive disease (PD). Serum CYFRA21-1 and CEA were significantly decreased compared to baseline levels (P<0.001). By ROC curve analysis, a ≥60% reduction in CYFRA21-1 and a ≥25% reduction in CEA were the optimal cut-off levels with best sensitivity and specificity for the diagnosis of radiologic OR. The median survival of all patients was 10.2 months (range 2.6-26.3). Univariate survival analysis showed that the Eastern Cooperative Oncology Group (ECOG) performance status (PS) score, radiologic OR, a ≥60% reduction in CYFRA21-1 and a ≥25% reduction in CEA were significant prognostic factors for better overall survival. The median overall survival time in patients with a ≥60% reduction in CYFRA21-1 was significantly longer than in those with a <60% reduction (P<0.001). Similarly, the median overall survival time in patients with a ≥25% reduction in CEA was also significantly longer than in those with a <25% reduction (P<0.001). Multivariate analysis showed that ECOG PS score, a ≥60% reduction in CYFRA21-1 and a ≥25% reduction in CEA were independent prognostic factors of survival, while radiologic OR was not. In conclusion, a ≥60% reduction in CYFRA21-1 and a ≥25% reduction in CEA may be reliable surrogate markers for the prediction of chemothrapy response and prognosis, especially for the diagnosis of radiologic OR.
本研究旨在探讨血清细胞角蛋白19片段（CYFRA21-1）和癌胚抗原（CEA）在预测晚期非小细胞肺癌（NSCLC）患者化疗反应及预后方面的临床价值。采用免疫放射分析试剂盒检测98例晚期NSCLC患者化疗2周期前后血清CYFRA21-1和CEA水平。化疗2周期后，45例患者达到影像学客观缓解（OR），30例患者疾病稳定（SD），23例患者疾病进展（PD）。与基线水平相比，血清CYFRA21-1和CEA显著降低（P<0.001）。通过ROC曲线分析，CYFRA21-1降低≥60%和CEA降低≥25%是诊断影像学OR的具有最佳敏感性和特异性的最佳截断水平。所有患者的中位生存期为10.2个月（范围2.6 - 26.3个月）。单因素生存分析显示，东部肿瘤协作组（ECOG）体能状态（PS）评分、影像学OR、CYFRA21-1降低≥60%和CEA降低≥25%是总体生存较好的显著预后因素。CYFRA21-1降低≥60%的患者中位总生存时间显著长于降低<60%的患者（P<0.001）。同样，CEA降低≥25%的患者中位总生存时间也显著长于降低<25%的患者（P<0.001）。多因素分析显示，ECOG PS评分、CYFRA21-1降低≥60%和CEA降低≥25%是生存的独立预后因素，而影像学OR不是。总之，CYFRA21-1降低≥60%和CEA降低≥25%可能是预测化疗反应和预后的可靠替代标志物，尤其是用于诊断影像学OR。
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