Chen Hao, Jiang Yan, Jia Keyi, Zhang Kaixuan, Matsuura Natsumi, Jeong Jin Yong, Su Bo, Zhou Xiao
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Transl Lung Cancer Res. 2021 Oct;10(10):3983-3994. doi: 10.21037/tlcr-21-833.
Patients with stage I lung adenocarcinoma (LUAD) have varying postoperative prognosis. This study aimed to investigate the prognostic significance of postoperative longitudinal change of serum carcinoembryonic antigen (CEA) level in patients with stage I LUAD.
The study cohort comprised 241 patients with stage I LUAD completely resected with single-port video-assisted thoracic surgery (VATS). The patients were categorized into 4 groups according to the postoperative longitudinal change of serum CEA levels measured in the third and sixth months after surgery: the NN group (continuously normal), HN group (increase first and then decrease), NH group (decrease first and then increase), and HH group (continuously high). Recurrence-free survival (RFS) was analyzed by the Kaplan-Meier method and compared by log-rank test. A nomogram was developed to predict recurrence in the stage I LUAD patients.
In univariate analysis, differentiation (P<0.001), visceral pleural invasion (VPI) (P=0.025), tumor diameter (P<0.001), tumor-node-metastasis (TNM) stage (P=0.008), preoperative CEA levels (≥10.0 <10.0 ng/mL, P<0.001), and postoperative CEA grouping (NH/HH NN/HN, P<0.001) were significant prognostic factors for stage I LUAD patients. Multivariate analysis showed that tumor diameter (P=0.009) and postoperative CEA grouping (P<0.001) were considered to be independent prognostic factors of postoperative recurrence of stage I LUAD. Tumor diameter (≥20 mm) and postoperative CEA (NH/HH vs. NN/HN) were associated with worse RFS. Receiver operating characteristic (ROC) curve analysis showed that postoperative CEA (NH/HH NN/HN) have high sensitivity (64.7%) and specificity (83.2%) for early prediction of postoperative recurrence of stage I LUAD. The area under curve (AUC) value was 0.745. The nomogram based on multivariate Cox regression had a concordance index (value of 0.789). The calibration plot showed that the predicted probabilities closely matched the observed probabilities.
Longitudinal change in serum CEA level after surgery was found to be an independent unfavorable prognostic factor in completely resected stage I LUAD patients. The NH group and HH group were significantly associated with worse RFS. A nomogram was established to predict the postoperative recurrence of patients with stage I LUAD.
Ⅰ期肺腺癌（LUAD）患者术后预后各异。本研究旨在探讨Ⅰ期LUAD患者术后血清癌胚抗原（CEA）水平的纵向变化对预后的意义。
研究队列包括241例行单孔电视辅助胸腔镜手术（VATS）完全切除的Ⅰ期LUAD患者。根据术后第3个月和第6个月测得的血清CEA水平的纵向变化，将患者分为4组：NN组（持续正常）、HN组（先升高后降低）、NH组（先降低后升高）和HH组（持续升高）。采用Kaplan-Meier法分析无复发生存期（RFS），并通过对数秩检验进行比较。绘制列线图以预测Ⅰ期LUAD患者的复发情况。
单因素分析中，分化程度（P<0.001）、脏层胸膜侵犯（VPI）（P=0.025）、肿瘤直径（P<0.001）、肿瘤-淋巴结-转移（TNM）分期（P=0.008）、术前CEA水平（≥10.0 <10.0 ng/mL，P<0.001）以及术后CEA分组（NH/HH NN/HN，P<0.001）是Ⅰ期LUAD患者的显著预后因素。多因素分析显示，肿瘤直径（P=0.009）和术后CEA分组（P<0.001）被认为是Ⅰ期LUAD术后复发的独立预后因素。肿瘤直径（≥20 mm）和术后CEA（NH/HH与NN/HN相比）与较差的RFS相关。受试者工作特征（ROC）曲线分析表明，术后CEA（NH/HH NN/HN）对Ⅰ期LUAD术后复发的早期预测具有较高的敏感性（64.7%）和特异性（83.2%）。曲线下面积（AUC）值为0.745。基于多因素Cox回归的列线图一致性指数（值为0.789）。校准图显示预测概率与观察概率密切匹配。
术后血清CEA水平的纵向变化是完全切除的Ⅰ期LUAD患者独立的不良预后因素。NH组和HH组与较差的RFS显著相关。建立了列线图以预测Ⅰ期LUAD患者的术后复发情况。
