Izhakian Shimon, Gagula Meir, Engelstein Haya, Malka Liel, Freidkin Lev, Rosengarten Dror, Kramer Mordechai Reuven
Pulmonary Institute, Rabin Medical Center Beilinson Hospital, Petah Tikva, Central, Israel
Tel Aviv University, Tel Aviv, Israel.
BMJ Open Respir Res. 2025 May 22;12(1):e002614. doi: 10.1136/bmjresp-2024-002614.
Advanced interstitial lung disease (ILD) often necessitates lung transplantation, and identifying accessible prognostic markers is essential for effective management. However, the link between serum tumour markers and survival in waitlisted lung transplant candidates with advanced ILD remains underexplored.
To evaluate associations between serum tumour marker levels and long-term survival in lung transplant candidates with advanced ILD.
This study included 282 patients with end-stage ILD who were waitlisted for lung transplantation from November 2012 to March 2021. Baseline data and serum tumour marker levels were assessed before listing. Vital status and transplant outcomes were retrospectively reviewed as of 31 May 2023. Associations between tumour markers, clinical variables and mortality were analysed using Cox proportional hazards models with competing risk regression.
During a median wait time of 17.8 months (IQR: 7.8-44.1), 107 patients received transplants, 38 survived on the list and 137 died while waiting. Multivariable analysis identified higher CA-125 levels (HR 1.03, 95% CI 1.01 to 1.06, p=0.001), older age (HR 1.03, 95% CI 1.01 to 1.06, p=0.001), female gender (HR 1.43, 95% CI 1.01 to 2.04, p<0.04), elevated C-reactive protein (HR 1.17, 95% CI 1.03 to 1.34, p=0.01) and cerebrovascular disease (HR 2.03, 95% CI 1.38 to 2.98, p=0.01) as significant predictors of mortality.
Among waitlisted lung transplant candidates with advanced ILD, elevated serum carbohydrate antigen (CA)-125 and CA19-9 levels are associated with higher mortality risk. Routine assessment of these markers may enhance risk stratification for this patient population.
晚期间质性肺疾病（ILD）常常需要进行肺移植，识别可获取的预后标志物对于有效管理至关重要。然而，血清肿瘤标志物与等待肺移植的晚期ILD患者生存率之间的联系仍未得到充分探索。
评估血清肿瘤标志物水平与晚期ILD肺移植候选者长期生存之间的关联。
本研究纳入了2012年11月至2021年3月期间等待肺移植的282例终末期ILD患者。在列入名单前评估基线数据和血清肿瘤标志物水平。截至2023年5月31日，对生存状态和移植结局进行回顾性分析。使用Cox比例风险模型和竞争风险回归分析肿瘤标志物、临床变量与死亡率之间的关联。
在中位等待时间17.8个月（四分位间距：7.8 - 44.1）期间，107例患者接受了移植，38例在名单上存活，137例在等待期间死亡。多变量分析确定较高的CA - 125水平（风险比1.03，95%置信区间1.01至1.06，p = 0.001）、年龄较大（风险比1.03，95%置信区间1.01至1.06，p = 0.001）、女性（风险比1.43，95%置信区间1.01至2.04，p < 0.04）、C反应蛋白升高（风险比1.17，95%置信区间1.03至1.34，p = 0.01）和脑血管疾病（风险比2.03，95%置信区间1.38至2.98，p = 0.01）是死亡率的显著预测因素。
在等待肺移植的晚期ILD候选者中，血清糖类抗原（CA）-125和CA19-9水平升高与较高的死亡风险相关。对这些标志物进行常规评估可能会加强对该患者群体的风险分层。
