Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
Acta Oncol. 2012 Sep;51(7):849-59. doi: 10.3109/0284186X.2012.705020.
To evaluate the predictive and prognostic value of serum and plasma tumor markers, in comparison with clinical and biomedical parameters for response rate (RR), progression-free survival (PFS) and overall survival (OS) among patients with metastatic colorectal cancer (mCRC) treated with combination chemotherapy.
One-hundred and six patients with mCRC from three centers, part of a multicenter study, received irinotecan with the Nordic bolus 5-fluorouracil (5-FU) and folinic acid schedule (FLIRI) or the de Gramont schedule (Lv5FU2-IRI). Blood samples for CEA, CA19-9, TPA, TIMP-1, SAA, transthyretin and CRP were taken at baseline and after two, four and eight weeks of treatment. Tumor marker levels at baseline and longitudinally were compared with responses evaluated (CT/MRI) after two and four months of treatment. The correlations to RR, PFS and OS were evaluated with regression analyses.
A significant correlation to OS was seen for baseline levels of all markers. In multivariate analyses with clinical parameters, TPA, CRP, SAA and TIMP-1 provided independent information. The baseline values of CEA, TPA and TIMP-1 were also significantly correlated to PFS and TPA to RR. Changes during treatment, i.e. the slope gave with the exception of CA19-9 for OS less information about outcomes. The best correlation to response was seen for CEA, CA19-9 and TPA with AUC values of 0.78, 0.83 and 0.79, respectively, using a combined model based upon an interaction between the slope and the baseline value.
Baseline tumor markers together with clinical parameters provide prognostic information about survival in patients with mCRC. The ability of the individual tumor markers to predict treatment response and PFS is limited. Changes in marker levels during the first two months of treatment are less informative of outcome.
评估血清和血浆肿瘤标志物的预测和预后价值，与临床和生物医学参数相比，转移性结直肠癌（mCRC）患者联合化疗的反应率（RR）、无进展生存期（PFS）和总生存期（OS）。
来自三个中心的 106 名 mCRC 患者，为多中心研究的一部分，接受了伊立替康联合北欧氟尿嘧啶（5-FU）和亚叶酸钙方案（FLIRI）或德格拉蒙方案（Lv5FU2-IRI）。在基线和治疗后 2、4 和 8 周时采集 CEA、CA19-9、TPA、TIMP-1、SAA、转甲状腺素和 CRP 的血液样本。在基线和纵向时比较了肿瘤标志物水平与治疗后 2 和 4 个月评估的反应（CT/MRI）。用回归分析评估与 RR、PFS 和 OS 的相关性。
所有标志物的基线水平与 OS 显著相关。在包括临床参数的多变量分析中，TPA、CRP、SAA 和 TIMP-1 提供了独立信息。CEA、TPA 和 TIMP-1 的基线值也与 PFS 显著相关，TPA 与 RR 相关。治疗期间的变化，即斜率除外 CA19-9 对 OS 提供的信息较少。CEA、CA19-9 和 TPA 的最佳相关性为 0.78、0.83 和 0.79，分别使用基于斜率和基线值之间相互作用的组合模型。
基线肿瘤标志物与临床参数一起提供了 mCRC 患者生存的预后信息。个体肿瘤标志物预测治疗反应和 PFS 的能力有限。治疗前两个月标志物水平的变化对结果的信息量较少。
