Tamura Masaya, Furukawa Naoki, Sakai Takashi, Yamamoto Marino, Miyazaki Ryohei, Okada Hironobu
Department of Thoracic Surgery, Kochi Medical School, Kohasu, Oko-Cho, Nankoku-City, Kochi, 783-8505, Japan.
J Cardiothorac Surg. 2024 Dec 20;19(1):662. doi: 10.1186/s13019-024-03166-z.
The aim of this research was to investigates the prognostic importance of change in carcinoembryonic antigen (CEA) levels (particularly abnormal high concentration) in patients with non-small cell lung cancer (NSCLC) between before and after surgery.
The study involved 68 patients with NSCLC ( preoperative CEA value ≥ 10 ng/ml) who received curative operation from 2012 to 2020. Preoperative and postoperative serum CEA levels, CEA reduction, and other clinicopathological factors were determined on medical records. Receiver operating characteristic curves were used to calculate cut-off levels for prognostic markers. Multivariate analyses with a Cox proportional hazards regression model were performed to identify Independent prognostic variables.
The optimal cut-off was value for the CEA reduction rate was 77.3%. The area under the curve for the CEA reduction rate was greater compared with those for preoperative and postoperative CEA levels. The Kaplan-Meier method revealed a significantly worse prognosis in the low CEA reduction rate group versus the high CEA reduction rate group regarding overall survival (OS) (p = 0.002). In the multivariate analysis, the CEA reduction rate (hazard ratio: 3.36, 95% confidence interval: 1.32-8.51, p = 0.011) was identified as an independent and exclusive prognostic marker for OS.
In NSCLC, which is characterized by high preoperative CEA levels, the CEA reduction rate after surgery is a useful prognostic factor. Importantly, it is a more powerful indicator for OS compared with postoperative CEA levels. Further, large-sample-size cohort studies focusing on this issue are warranted.
本研究旨在探讨非小细胞肺癌（NSCLC）患者手术前后癌胚抗原（CEA）水平变化（尤其是异常高浓度）的预后重要性。
该研究纳入了2012年至2020年期间接受根治性手术的68例NSCLC患者（术前CEA值≥10 ng/ml）。根据病历确定术前和术后血清CEA水平、CEA降低情况及其他临床病理因素。采用受试者工作特征曲线计算预后标志物的截断水平。使用Cox比例风险回归模型进行多变量分析，以识别独立的预后变量。
CEA降低率的最佳截断值为77.3%。CEA降低率的曲线下面积大于术前和术后CEA水平的曲线下面积。Kaplan-Meier方法显示，低CEA降低率组与高CEA降低率组相比，总生存期（OS）的预后明显更差（p = 0.002）。在多变量分析中，CEA降低率（风险比：3.36，95%置信区间：1.32 - 8.51，p = 0.011）被确定为OS的独立且唯一的预后标志物。
在术前CEA水平较高的NSCLC中，术后CEA降低率是一个有用的预后因素。重要的是，与术后CEA水平相比，它是OS的一个更有力的指标。此外，有必要开展针对此问题的大样本队列研究。
