Ozeki Naoki, Fukui Takayuki, Taniguchi Tetsuo, Usami Noriyasu, Kawaguchi Koji, Ito Simon, Sakao Yukinori, Mitsudomi Tetsuya, Hirakawa Akihiro, Yokoi Kohei
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Eur J Cardiothorac Surg. 2014 Apr;45(4):687-92. doi: 10.1093/ejcts/ezt424. Epub 2013 Aug 26.
The purpose of this study was to elucidate the detectability of recurrence and the prognostic significance of the serum carcinoembryonic antigen (CEA) levels in patients with completely resected non-small-cell lung cancer (NSCLC).
Five hundred and eighteen NSCLC patients who underwent complete resection at Aichi Cancer Center between April 2001 and March 2006 were enrolled in this study. The patient characteristics were as follows: the median age was 63 years; 331 tumours were classified as pathological stage I, 88 tumours were pathological stage II and 99 tumours were pathological stage III; 140 tumours were adenocarcinomas with epidermal growth factor receptor (EGFR) mutations, 268 tumours were adenocarcinomas with EGFR wild-type mutations and 110 tumours were other NSCLCs. The patients were divided into three groups: those with a normal CEA level before and 1-3 months after surgery (N group, n = 380), those with an elevated CEA level before surgery and a normal CEA level 1-3 months after surgery (HN group, n = 105) and those with an elevated CEA level 1-3 months after surgery regardless of the preoperative CEA level (H group, n = 33). The correlations between the changes in the serum CEA levels and the clinical outcomes were analysed.
Recurrence developed in 122 patients (32%) in the N group, 49 patients (47%) in the HN group and 19 patients (58%) in the H group (P = 0.001). The sensitivity and specificity of an elevated serum CEA level during the follow-up period for detecting recurrence were 30 and 98% in the N group and 82 and 73% in the HN group, respectively. Twenty-seven asymptomatic recurrent tumours combined with an elevated serum CEA level were detected in the HN group. In the multivariate Cox regression analysis, the serum CEA level 1-3 months after surgery had prognostic value for overall survival.
In completely resected NSCLC patients, measuring the serum CEA level during the follow-up period is useful in patients in whom an elevated level normalizes after surgery, and the serum CEA level 1-3 months after surgery is considered to have prognostic significance regarding survival.
本研究旨在阐明完全切除的非小细胞肺癌（NSCLC）患者复发的可检测性以及血清癌胚抗原（CEA）水平的预后意义。
纳入2001年4月至2006年3月在爱知癌症中心接受完全切除的518例NSCLC患者。患者特征如下：中位年龄为63岁；331例肿瘤分类为病理I期，88例肿瘤为病理II期，99例肿瘤为病理III期；140例肿瘤为具有表皮生长因子受体（EGFR）突变的腺癌，268例肿瘤为具有EGFR野生型突变的腺癌，110例肿瘤为其他NSCLC。患者分为三组：术前及术后1 - 3个月CEA水平正常的患者（N组，n = 380），术前CEA水平升高但术后1 - 3个月CEA水平正常的患者（HN组，n = 105），以及无论术前CEA水平如何术后1 - 3个月CEA水平升高的患者（H组，n = 33）。分析血清CEA水平变化与临床结局之间的相关性。
N组122例患者（32%）出现复发，HN组49例患者（47%）出现复发，H组19例患者（58%）出现复发（P = 0.001）。随访期间血清CEA水平升高用于检测复发的敏感性和特异性在N组分别为30%和98%，在HN组分别为82%和73%。HN组检测到27例无症状复发肿瘤合并血清CEA水平升高。在多因素Cox回归分析中，术后1 - 3个月的血清CEA水平对总生存具有预后价值。
在完全切除的NSCLC患者中，随访期间检测血清CEA水平对术后CEA水平升高后恢复正常的患者有用，且术后1 - 3个月的血清CEA水平被认为对生存具有预后意义。
