Zhao Tongwei, Jin Ying, Mao Guangyun, Wei Yaping, Wu Guoqing, Ye Xiao, Zhou Yonglie, Yuan Guorong, Gao Liang, Hong Yupeng, Chen Yun, Hong Chaojin, Zhou Hongying, Su Dan, Qin Zhiquan, Lu Liqin
Department of Medical Oncology, Zhejiang Provincial People's Hospital Department of Medical Oncology, Zhejiang Cancer Hospital Department of Preventive Medicine, School of Environmental Science & Public Health, Wenzhou Medical University Center on Clinical & Epidemiological Eye Research, the Affiliated Eye Hospital of Wenzhou Medical University Department of Endocrinology, Zhejiang Provincial People's Hospital Clinical Laboratory Center, Zhejiang Provincial People's Hospital, Zhejiang, P.R. China.
Medicine (Baltimore). 2016 Dec;95(52):e5748. doi: 10.1097/MD.0000000000005748.
Serum cytokeratin 19 fragment (CYFRA21-1) has been found to be a useful prognostic marker in lung cancer. Previous studies have revealed that change in CYFRA21-1 synchronously predicted therapeutic effectiveness in advanced nonsmall cell lung cancer (NSCLC) after the second cycle of chemotherapy. The objective of this study was to investigate the early predictive value of percentage change in serum CYFRA21-1 from pretreatment to completion of the first cycle of chemotherapy for chemotherapeutic effectiveness in advanced NSCLC patients.Ninety-seven advanced NSCLC patients with elevated serum CYFRA21-1 level (≥3.8 μg/L), who received 2 platinum-containing drugs, were included in this retrospective study. Serum CYFRA21-1 had been assayed before and after the first cycle of chemotherapy. To evaluate the effectiveness of chemotherapy, patients were allocated to disease control (DC) and progressive disease groups. The percentage changes of serum CYFRA21-1 concentration before and after first-cycle chemotherapy that occurred in each group were evaluated for their ability to predict achievement of radiologic DC, that is, to predict therapeutic effectiveness.The percentage change of serum CYFRA21-1 and the prevalence of ≥5% weight loss were higher in patients with progressive disease than in those with DC. The differences in other clinical and pathological variables including age, sex, Eastern Cooperative Oncology Group (ECOG) performance status, cigarette smoking, histological type, gross type, clinical stage, and chemotherapy regimens of the 2 groups were not significant. Both multiple generalized linear model analysis and linear trend tests indicated that the percentage change of serum CYFRA21-1 concentration was independently and negatively linked to the effectiveness of chemotherapy for NSCLC (P < 0.01). The area under the receiver-operating characteristic curve of the percentage change in prediction of DC was 0.84 and the optimal cut-off value was17.5% (P < 0.001).The percentage change of serum CYFRA21-1 after completing the first cycle of chemotherapy was predictive of treatment effects and might be helpful in making early decisions to change chemotherapy regimens in patients with advanced NSCLC.
血清细胞角蛋白19片段（CYFRA21-1）已被发现是肺癌中一种有用的预后标志物。先前的研究表明，CYFRA21-1的变化同步预测了晚期非小细胞肺癌（NSCLC）在化疗第二个周期后的治疗效果。本研究的目的是探讨血清CYFRA21-1从预处理到完成第一个化疗周期的百分比变化对晚期NSCLC患者化疗效果的早期预测价值。本回顾性研究纳入了97例血清CYFRA21-1水平升高（≥3.8μg/L）且接受含铂双药治疗的晚期NSCLC患者。在第一个化疗周期前后检测血清CYFRA21-1。为了评估化疗效果，将患者分为疾病控制（DC）组和疾病进展组。评估每组在第一个化疗周期前后血清CYFRA21-1浓度的百分比变化预测放射学DC的能力，即预测治疗效果。疾病进展患者的血清CYFRA21-1百分比变化和体重减轻≥5%的发生率高于DC患者。两组在年龄、性别、东部肿瘤协作组（ECOG）体能状态、吸烟、组织学类型、大体类型、临床分期和化疗方案等其他临床和病理变量方面的差异不显著。多元广义线性模型分析和线性趋势检验均表明，血清CYFRA21-1浓度的百分比变化与NSCLC化疗效果独立且呈负相关（P<0.01）。预测DC的百分比变化的受试者工作特征曲线下面积为0.84，最佳截断值为17.5%（P<0.001）。完成第一个化疗周期后血清CYFRA21-1的百分比变化可预测治疗效果，并可能有助于对晚期NSCLC患者做出早期更改化疗方案的决策。
