Yoshimasu T, Miyoshi S, Maebeya S, Suzuma T, Bessho T, Hirai I, Tanino H, Arimoto J, Naito Y
Department of Thoracic and Cardiovascular Surgery, Wakayama Medical College, Wakayama City, Japan.
Cancer. 1997 Apr 15;79(8):1533-40. doi: 10.1002/(sici)1097-0142(19970415)79:8<1533::aid-cncr14>3.0.co;2-z.
The serum kinetics of carcinoembryonic antigen (CEA) after resection of lung carcinoma are not well characterized. Its prognostic implications remain unclear. This study was designed to clarify the correlation between postoperative CEA time-course and patient prognosis.
The authors analyzed early postoperative CEA time-course in 31 lung carcinoma patients using nonlinear least square analysis with the following three equations: Equation 1: C(t) = C(0); Equation 2: C(t) = C(0)exp(-kt); and Equation 3: C(t) (C(0)PLAT)exp(-kt) + PLAT, in which t: postoperative day; C(t): postoperative CEA; PLAT: postoperative CEA at plateau; C(0): CEA at postoperative Day zero; and k: rate constant of elimination. The equation that yielded the least Akaike's information criterion was adopted as the best fitting regression equation for each patient. When Equation 3 was adopted, postoperative CEA production (PROD) was calculated as PLAT multiplied by k.
Equations 1, 2, and 3 were adopted for 16 (Group 1), 0, and 15 (Group 2) patients, respectively. In Group 1, no decrease in serum CEA level after surgery was detected and CEA production appears to have been little or none. In Group 2, biologic CEA half-life was 1.1 +/- 0.7 days and was not useful for predicting patient prognosis. Tumor recurrences were observed in 9 of the Group 2 patients 19 +/- 9 months postoperatively and there was no significant difference in PLAT or PROD between patients with and without recurrence. Early recurrence within 6 months after surgery was recognized in 5 (early-REC) of the 15 Group 2 patients, in whom there was a tendency for PLAT to be higher than in the other 10 patients without recurrence (early-NON) (early-REC: 3.8 +/- 4.9 ng/mL; early-NON: 1.5 +/- 1.1 ng/mL; P = 0.08). PROD was significantly higher in early-REC than in early-NON (early-REC: 3.5 +/- 4.2 ng/mL/day; early-NON: 0.8 +/- 0.4 ng/mL/day; P < 0.05).
Although PROD is more sensitive than PLAT, both parameters appear to be useful as prognostic tools for predicting early recurrence after resection of lung carcinoma. This is probably because they represent the number of residual tumor cells immediately after surgery.
肺癌切除术后癌胚抗原（CEA）的血清动力学特征尚不明确。其预后意义仍不清楚。本研究旨在阐明术后CEA时间进程与患者预后之间的相关性。
作者使用非线性最小二乘法分析了31例肺癌患者术后早期的CEA时间进程，采用以下三个方程：方程1：C(t)=C(0)；方程2：C(t)=C(0)exp(-kt)；方程3：C(t)=(C(0)-PLAT)exp(-kt)+PLAT，其中t为术后天数；C(t)为术后CEA；PLAT为平台期术后CEA；C(0)为术后第0天的CEA；k为消除速率常数。产生最小赤池信息准则的方程被用作每位患者的最佳拟合回归方程。当采用方程3时，术后CEA产生量（PROD）计算为PLAT乘以k。
方程1、2和3分别应用于16例（第1组）、0例和15例（第2组）患者。在第1组中，术后未检测到血清CEA水平下降，CEA产生量似乎很少或没有。在第2组中，生物学CEA半衰期为1.1±0.7天，对预测患者预后无用。第2组中有9例患者在术后19±9个月出现肿瘤复发，复发患者与未复发患者的PLAT或PROD无显著差异。15例第2组患者中有5例（早期复发组）在术后6个月内出现早期复发，其中PLAT有高于其他10例未复发患者（早期未复发组）的趋势（早期复发组：3.8±4.9 ng/mL；早期未复发组：1.5±1.1 ng/mL；P=0.08）。早期复发组的PROD显著高于早期未复发组（早期复发组：3.5±4.2 ng/mL/天；早期未复发组：0.8±0.4 ng/mL/天；P<0.05）。
尽管PROD比PLAT更敏感，但这两个参数似乎都可作为预测肺癌切除术后早期复发的预后工具。这可能是因为它们代表了手术后立即残留的肿瘤细胞数量。
