Allen-Mersh T G, Kemeny N, Niedzwiecki D, Shurgot B, Daly J M
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Gut. 1987 Dec;28(12):1625-9. doi: 10.1136/gut.28.12.1625.
'Tumour response', defined as clinical or radiological evidence of tumour shrinkage is frequently regarded as an objective of chemotherapy, rather than as a predictor of prolonged survival. This study has assessed whether a fall in the serum CEA concentration after chemotherapy for disseminated colorectal cancer is a predictor of prolonged survival and compared it with tumour response as a predictor of survival. There was a 37% improvement in median survival among patients whose serum CEA concentration fell after chemotherapy (70% of patients treated) compared with patients whose serum CEA did not fall. The use of greater than 25% clinical or radiological tumour shrinkage as a predictor of prolonged survival identified a smaller proportion (36%) of patients in whom there was a 52% prolongation in median survival compared with patients whose tumours shrank less than 25%, or did not shrink. Proportional hazards regression analysis suggested that tumour shrinkage was a stronger predictor of survival. A fall in serum CEA concentration, however, identified a group of patients whose tumours did not shrink, but who had a 27% improvement in median survival compared with those whose tumours did not shrink and whose serum CEA concentration did not fall. Monitoring of the serum CEA during the first two months of treatment appears to provide a sensitive and economical means of identifying those patients whose survival is likely to be prolonged by chemotherapy for colorectal cancer.
“肿瘤反应”被定义为肿瘤缩小的临床或影像学证据，它常被视为化疗的一个目标，而非延长生存期的预测指标。本研究评估了播散性结直肠癌化疗后血清癌胚抗原（CEA）浓度下降是否为延长生存期的预测指标，并将其与作为生存期预测指标的肿瘤反应进行比较。与血清CEA浓度未下降的患者相比，化疗后血清CEA浓度下降的患者（占接受治疗患者的70%）中位生存期提高了37%。将大于25%的临床或影像学肿瘤缩小作为延长生存期的预测指标，与肿瘤缩小小于25%或未缩小的患者相比，能确定的中位生存期延长52%的患者比例更小（36%）。比例风险回归分析表明肿瘤缩小是更强的生存期预测指标。然而，血清CEA浓度下降确定了一组肿瘤未缩小但中位生存期比肿瘤未缩小且血清CEA浓度未下降的患者提高了27%的患者。在治疗的前两个月监测血清CEA似乎为识别那些可能通过结直肠癌化疗延长生存期的患者提供了一种敏感且经济的方法。
