Suh Koung Jin, Keam Bhumsuk, Kim Miso, Park Young Sik, Kim Tae Min, Jeon Yoon Kyung, Kim Dong-Wan, Chung Doo Hyun, Kim Young Whan, Heo Dae Seog
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Clin Lung Cancer. 2016 Jul;17(4):245-252.e1. doi: 10.1016/j.cllc.2015.11.012. Epub 2015 Nov 30.
Our study aimed to determine the predictive and prognostic values of the serum neuron-specific enolase (NSE) level in patients who had non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations and who had been treated with EGFR-tyrosine kinase inhibitors (TKIs).
We retrospectively analyzed 151 patients who had NSCLC harboring EGFR mutations and had received either gefitinib or erlotinib as first-line treatment between 2005 and 2014. The serum NSE level was measured before initiation of EGFR-TKI treatment.
Of the 151 patients, 92 (60.9%) had elevated NSE levels (> 16.3 ng/mL). Patients with elevated NSE levels showed significantly shorter progression-free survival (PFS) after EGFR-TKI treatment than those with normal NSE levels (median PFS, 10.5 months vs. 15.4 months; P = .034). Multivariate analysis demonstrated that elevated NSE levels (hazard ratio [HR], 1.656; P = .017), CNS metastasis at diagnosis (HR, 1.567; P = .037), and male gender (HR, 1.840; P = .005) were independent predictive factors for short PFS. A significant difference in overall survival (OS) was observed between patient groups with elevated and normal NSE levels (median OS, 17.0 months vs. 29.1 months; P < .001), and serum NSE level remained an independent prognostic factor for OS in multivariate analysis (HR, 2.671; P < .001).
Patients with elevated serum NSE levels have significantly shorter PFS and OS. The NSE level is both a predictive marker of EGFR-TKI treatment and a prognostic marker in EGFR-mutant NSCLC patients.
我们的研究旨在确定血清神经元特异性烯醇化酶（NSE）水平对携带表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者以及接受EGFR酪氨酸激酶抑制剂（TKIs）治疗的患者的预测价值和预后价值。
我们回顾性分析了151例携带EGFR突变的NSCLC患者，这些患者在2005年至2014年间接受了吉非替尼或厄洛替尼作为一线治疗。在开始EGFR-TKI治疗前测量血清NSE水平。
151例患者中，92例（60.9%）NSE水平升高（>16.3 ng/mL）。NSE水平升高的患者在接受EGFR-TKI治疗后的无进展生存期（PFS）明显短于NSE水平正常的患者（中位PFS，10.5个月对15.4个月；P = 0.034）。多因素分析表明，NSE水平升高（风险比[HR]，1.656；P = 0.017）、诊断时发生中枢神经系统转移（HR，1.567；P = 0.037）和男性（HR，1.840；P = 0.005）是PFS短的独立预测因素。NSE水平升高和正常的患者组之间总生存期（OS）存在显著差异（中位OS，17.0个月对29.1个月；P < 0.001），并且在多因素分析中血清NSE水平仍然是OS的独立预后因素（HR，2.671；P < 0.001）。
血清NSE水平升高的患者PFS和OS明显较短。NSE水平既是EGFR-TKI治疗的预测标志物，也是EGFR突变NSCLC患者的预后标志物。
