癌胚抗原和细胞角蛋白19片段作为晚期非小细胞肺癌疗效评价指标的临床价值

Clinical value of CEA and CYFRA21-1 as an assessment indicator of therapeutic efficacy in advanced non-small cell lung cancer patients

目的 研究癌胚抗原（CEA）和细胞角蛋白19片段（CYFRA21-1）作为晚期非小细胞肺癌（NSCLC）疗效评价指标的价值.方法 以血清肿瘤标志物CEA和（或）CYFRA21-1升高的228例初治NSCLC患者为研究对象,所有患者均采用以化疗为主的治疗手段.采用回顾性研究方法,按照实体瘤疗效评价标准（RECIST）判断疗效,并分析治疗前后血清肿瘤标志物的变化与近期疗效及无进展生存时间（PFS）的关系.结果 228例患者中,部分缓解（PR）40例,稳定（SD）151例,进展（PD）37例.按照血清肿瘤标志物的变化率将患者分为下降组、升高组和稳定组,CEA下降组90例,稳定组49例,升高组66例;CYFRA21～1下降组84例,稳定组26例,升高组37例.PR患者在CEA和CYFRA21-1下降组中分别占68.4%和88.9%,在升高组中分别占7.9%和5.6%;PD患者在CEA和CYFRA21-1升高组分别占59.4%和76.2%,而下降组中无PD患者;SD患者介于两者之间.血清肿瘤标志物的变化率与影像学疗效评价显著相关（rCEA=0.45,PCEA=0.00;rCYFRA21-1=0.44,PCYFRA21-1=0.00）.不同肿瘤标志物变化组患者的PFS差异有统计学意义（均P＜0.05）,并可区分SD亚组患者的预后.结论 治疗前后CEA和CYFRA21-1的变化可以预测NSCLC患者的影像学疗效及PFS,并可将SD患者进一步划分为不同的疗效及预后亚组,有利于SD患者的个体化治疗.

Objective To investigate the value of carcinoembryonic antigen （CEA） or cytokeratin 19 fragment （ CYFRA21-1 ） as an assessment indicator of therapeutic efficacy in advanced non-small cell lung cancer （NSCLC） patients. Methods 228 cases of advanced NSCLC with chemotherapy were enrolled into this retrospective study. The serum CEA or CYFRA21-1 levels of all patients were above the cut-off limit before treatment. The relationship between changes of tumor markers （TMs） and imaging therapeutic efficacy or progression-free survival （PFS） was analyzed, and the value of TMs in therapeutic efficacy assessment was evaluated. Results According to RECIST criteria, partial response （PR） occurred in 40 cases, stable disease （SD） in 151 and PD （progressive disease） in 37. The cut-off values of the changes of TMs between pre- and post-treatment were determined according to the above mentioned criteria. The CEA down （D）, stable （S）, above （A） groups were 90, 49 and 66 cases, respectively. CYFRA21-1 down （D）, stable （S）, above （A） groups were 84, 26 and 37 cases, respectively. PR groups were 68.4% and 88.9% in CEA and cyfra21-1 down groups, respectively, 7. 9% and 5. 6% in the above groups,respectively. PD groups were 59.4% and 76.2% in CEA and CYFRA21-1 above groups, respectively. No PD cases were in the down groups. The changes of TMs in SD group were between them. Statistically significant correlations were observed between changes of TMs and imaging therapeutic efficacy （rCEA =0.45, P =0. 00;rCYFRA21-1 =0.44,P =0. 00）. PFS among different TMs groups were significantly different （all P 〈0. 05）, which can be used to further distinguish the prognosis among SD subgroups. Conclusion Changes of TMs can be used to predict the imaging therapeutic effect and PFS of the patients, and if the SD group is divided into subgroups according to different therapeutic efficacy and prognosis, it may help the patients to receive individualized treatment.