术前外周血CYFRA21-1水平对非小细胞肺癌手术患者预后的影响

Influence of preoperative peripheral blood CYFRA21-1 level on the prognosis of non-small-cell lung cancer patients

目的 探讨术前外周血CYFRA21-1水平与非晚期非小细胞肺癌（NSCLC）患者术后长期生存的关系。方法 回顾性分析2006年8月－2009年12月接受手术治疗的209例Ⅰ-Ⅲ期NSCLC患者的临床资料。以外周血CYFRA21-1正常值（〈3.3ng/ml）为基准将患者分成高水平组（n=103）和低水平组（n=106），通过Kaplan-Meier法和Cox比例风险模型分析外周血CYFRA21-1水平与NSCLC患者术后预后的关系。结果 209例患者中男性161例，女性48例，年龄57.9±9.7岁，中位生存时间29个月。Kaplan-Meier分析提示，与低水平组比较，高水平组患者预后较差，差异有统计学意义（Log-rank，P〈0.001）。Cox比例风险模型分析提示，术前外周血CYFRA21-1水平增高与NSCLC术后预后不良显著相关（单因素HR=2.06，95%CI 1.35-3.14，P〈0.001；多因素HR=1.69，95%CI 1.04-2.74，P=0.034）。分层分析提示，在肺腺癌（HR=2.45，P=0.017）和Ⅰ期肺癌患者（HR=15.41，P=0.003）中，CYFRA21-1水平增高与NSCLC预后不良显著相关。结论 在经手术治疗的Ⅰ-Ⅲ期NSCLC患者中，术前CYFRA21-1水平增高可能是其术后预后不良的危险因素。

Objective To explore the relationship between preoperative peripheral blood CYFRA21-1 level and the long-term survival of patients with non-advanced-stage non-small-cell lung cancer （NSCLC）. Methods The clinical data of 209 patients with NSCLC of stage Ⅰ-Ⅲ receiving surgical treatment from August 2006 to December 2009 were analyzed retrospectively. The patients were divided into high CYFRA21-1 level group （n=103） and low CYFRA21-1 level group （n=106） according to the normal value of peripheral blood CYFRA21-1 level （〈3.3 ng/ml）. The relationship between peripheral blood CYFRA21-1 level and postoperative prognosis of NSCLC patients were analyzed using Kaplan-Meier method and Cox proportional hazards model. Results There were 161 males and 48 females among 209 patients, with the mean age of 57.9±9.7 years, and the median survival time was 29 months. Kaplan-Meier analysis showed that the prognosis of high level group was worse than that of low level group （log-rank, P〈0.001）. Cox proportional hazards model analysis showed that the high preoperative peripheral blood CYFRA 21-1 level was significantly related to poorer postoperative prognosis of NSCLC patients （univariate analysis： HR=2.06, 95%CI 1.35-3.14, P〈0.001; multivariate analysis： HR=1.69, 95%CI 1.042.74, P=0.034）. The stratified analysis showed that the high CYFRA21-1 level was significantly related to poorer prognosis in lung adenocarcinoma patients （HR=2.45, P=0.017） and stage Ⅰ NSCLC patients （HR=15.41, P=0.003）. Conclusion High preoperative CYFRA21-1 level may be a predictive factor for poor prognosis in stages I-III NSCLC patients undergoing surgical resection.