Zhang Fangyuan, Zhai Menglan, Yang Jinru, Zhao Lei, Lin Zhenyu, Wang Jing, Zhang Tao, Yu Dandan
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Therap Adv Gastroenterol. 2022 Sep 28;15:17562848221124029. doi: 10.1177/17562848221124029. eCollection 2022.
Transient tumor marker elevations caused by chemotherapy were defined as 'Flare' and have been demonstrated in some solid tumors. In clinical practice, we observed that some patients were accompanied by elevated tumor markers during treatment, but subsequent imaging proved that the treatment they received was effective.
We aimed to study the Flare and the prognosis in advanced gastric cancer.
This is an observational retrospective study. A total of 167 patients were enrolled in this study. Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9 and CA125 values were obtained before the first, second, third, fourth, fifth and sixth cycles of treatment, respectively.
Imaging for the first efficacy assessment was reviewed according to the Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) criteria. Kaplan-Meier analyses and log-rank tests were performed for overall survival (OS) analyses. Univariate and multivariate Cox analyses were used to determine the prognostic factor for OS and progression-free survival (PFS).
37.1% of patients were accompanied with at least one tumor marker Flare during the course of treatment. The median time to tumor marker peak was 24-30 days and the Flare duration lasted 49-53 days. Patients with tumor markers Flare had a worse OS. Flare may be associated with the use of 5-fluorouracil. Baseline CEA and CA125 levels were the independent prognostic factors for OS and baseline CA125 level was the independent prognostic factor for PFS.
Initial elevation of tumor markers during treatment is not an indication of tumor progression. Patients with tumor markers 'Flare' may had a worse OS.
化疗引起的肿瘤标志物短暂升高被定义为“耀斑现象”，已在一些实体瘤中得到证实。在临床实践中，我们观察到一些患者在治疗期间伴有肿瘤标志物升高，但随后的影像学检查证明他们接受的治疗是有效的。
我们旨在研究晚期胃癌中的耀斑现象及其预后。
这是一项观察性回顾性研究。本研究共纳入167例患者。分别在治疗的第1、2、3、4、5和6周期前获取癌胚抗原（CEA）、糖类抗原（CA）19-9和CA125值。
根据实体瘤疗效评价标准1.1（RECIST 1.1）标准对首次疗效评估的影像学检查进行回顾。采用Kaplan-Meier分析和对数秩检验进行总生存（OS）分析。单因素和多因素Cox分析用于确定OS和无进展生存（PFS）的预后因素。
37.1%的患者在治疗过程中伴有至少一种肿瘤标志物耀斑现象。肿瘤标志物达到峰值的中位时间为24 - 30天，耀斑持续时间为49 - 53天。出现肿瘤标志物耀斑现象的患者OS较差。耀斑现象可能与5-氟尿嘧啶的使用有关。基线CEA和CA125水平是OS的独立预后因素，基线CA125水平是PFS的独立预后因素。
治疗期间肿瘤标志物的初始升高并非肿瘤进展的指征。出现肿瘤标志物“耀斑现象”的患者OS可能较差。
