[神经元特异性烯醇化酶、胃泌素释放肽前体及乳酸脱氢酶在小细胞肺癌患者诊断与治疗中的应用]

[Utility of NSE, ProGRP and LDH in Diagnosis and Treatment in Patients with Small Cell Lung Cancer].

作者信息

Peng Yan, Wang Yan, Li Junling, Hao Xuezhi, Hu Xingsheng

机构信息

Department of Medical Oncology, Beijing Chaoyang Sanhuan Cancer Hospital, Beijing 100021, China.

Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China.

出版信息

Zhongguo Fei Ai Za Zhi. 2016 Sep 20;19(9):590-4. doi: 10.3779/j.issn.1009-3419.2016.09.05.

DOI:10.3779/j.issn.1009-3419.2016.09.05

PMID:27666548

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5972956/

Abstract

BACKGROUND

Small cell lung cancer (SCLC) is a rapidly growing tumor with characteristic of neuroendocrine cellular function. Neuron specific enolase (NSE), pro-gastrin-releasing peptide (ProGRP) and lactic dehydrogenase (LDH) are valuable in diagnosis and treatment of SCLC. By analyzing the variation of NSE, ProGRP and LDH before and after treatment, the aim of this study is to investigate the efficacy of tumor markers in diagnostic staging, therapeutic evaluation and prediction of disease relapsing.

METHODS

Patients with SCLC who receiving the first line chemotherapy in Cancer Hospital, Chinese Academy of Medical Sciences were enrolled and retrospectively analyzed. Clinical characteristic (includes NSE, ProGRP and LDH level before and after 2 cycles chemotherapy), efficacy evaluation, progression-free survival (PFS) were analyzed.

RESULTS

Before treatment, Serum NSE, ProGRP and LDH in patients with extensive disease (ED) were significantly higher than those with limited disease (LD)(all P<0.005); NSE level increased obviously accompanied by increase of lymph nodes stage in LD group (P=0.010); Patients with weight reduction when diagnosis had higher NSE and LDH than those without loss of weight (P=0.032, P=0.014). After 2 cycles chemotherapy, decrease of NSE and ProGRP in effective group was higher than which in stable and ineffective groups (P=0.015, P=0.002). The relapse risk was lower in patients who accepted >4 cycles chemotherapy and with obvious decrease of ProGRP than those who accepted ≤4 cycles chemotherapy and with less obvious decrease of ProGRP in LD group; ED patients with no more than 2 distant metastasis, normal LDH level before treatment and obvious decrease of ProGRP after chemotherapy had lower short term relapse risk. In addition, the types of relapse (sensitive relapse, drug resistance relapse and refractory relapse) were negatively correlated with decrease of ProGRP (P=0.044). By multivariate analysis, numbers of chemotherapy cycle was independent prognostic factor for PFS in LD SCLC; numbers of distant metastasis and decrease of ProGRP were independent prognostic factors for PFS in ED SCLC.

CONCLUSIONS

Increase level of serum tumor markers is related to tumor burden. Decrease level of ProGRP after treatment may prognose efficacy and relapse risk.

摘要

背景

小细胞肺癌（SCLC）是一种生长迅速的肿瘤，具有神经内分泌细胞功能特征。神经元特异性烯醇化酶（NSE）、胃泌素释放肽前体（ProGRP）和乳酸脱氢酶（LDH）在SCLC的诊断和治疗中具有重要价值。通过分析治疗前后NSE、ProGRP和LDH的变化，本研究旨在探讨肿瘤标志物在诊断分期、疗效评估和疾病复发预测中的作用。

方法

纳入在中国医学科学院肿瘤医院接受一线化疗的SCLC患者，并进行回顾性分析。分析临床特征（包括2周期化疗前后的NSE、ProGRP和LDH水平）、疗效评估、无进展生存期（PFS）。

结果

治疗前，广泛期（ED）患者的血清NSE、ProGRP和LDH显著高于局限期（LD）患者（均P<0.005）；LD组中，NSE水平随淋巴结分期增加而明显升高（P=0.010）；诊断时体重减轻的患者NSE和LDH高于未体重减轻的患者（P=0.032，P=0.014）。2周期化疗后，有效组NSE和ProGRP的下降幅度高于稳定组和无效组（P=0.015，P=0.002）。在LD组中，接受>4周期化疗且ProGRP明显下降的患者复发风险低于接受≤4周期化疗且ProGRP下降不明显的患者；ED患者远处转移不超过2个、治疗前LDH水平正常且化疗后ProGRP明显下降者短期复发风险较低。此外，复发类型（敏感复发、耐药复发和难治复发）与ProGRP的下降呈负相关（P=0.044）。多因素分析显示，化疗周期数是LD-SCLC患者PFS的独立预后因素；远处转移数和ProGRP的下降是ED-SCLC患者PFS的独立预后因素。