血清癌胚抗原与非小细胞肺癌患者EGFR突变的关系及其对预后的影响

Relationship between serum carcinoembryonic antigen level and epidermal growth factor receptor mutations and prognosis in resected non-small cell lung cancer

目的：探讨血清癌胚抗原（CEA）水平与非小细胞肺癌患者EGFR基因突变的关系及预测价值，分析CEA水平对肺癌患者术后生存期的影响。方法：选取2009年3月至2011年3月于天津医科大学肿瘤医院肺部肿瘤科行外科手术治疗的患者387例，术前行CEA等肿瘤标志物检测，术后常规行EGFR基因突变检测，分析CEA等肿瘤标志物与EGFR突变关系及其与患者预后的关系。结果：全组患者中出现EGFR基因突变的患者共168例，突变阳性率43.4%，EGFR突变在女性、非吸烟、腺癌以及年龄〈60岁的患者中更加常见（P〈0.05），另发现EGFR突变情况与肿瘤标志物及化疗敏感性指标相关，EGFR野生型患者的Cyfra21-1、SCC升高、ERCC1阳性表达更常见（P〈0.05），而EGFR基因突变患者的CEA升高则更常见（P=0.015），并且随着CEA水平的升高，EGFR基因突变阳性率更高（血清CEA水平〈5μg/L、5～20μg/L及〉20μg/L 3组的阳性率分别为40.1%、47.5%和66.6%，P=0.003）。Logistic回归分析发现CEA水平是预测EGFR基因突变的独立因素，并且血清CEA水平也是影响非小细胞肺癌患者预后的独立因素（CEA水平升高组与正常组2年生存率分别为75.9%和88.4%，P〈0.01）。结论：血清CEA水平高低可以预测手术切除的非小细胞肺癌患者的预后，并且与非小细胞患者EGFR突变相关，可以初步指导EGFR突变情况。

Objective：To investigate the relationship between serum carcinoembryonic antigen （CEA） and the predictive value of epidermal growth factor receptor （EGFR） mutations in non-small cell lung cancer patients, as well as to analyze further EGFR muta-tions and CEA levels affecting patient survival. Methods：From March 2009 to March 2011, a total of 387 cases were treated in the Lung Cancer Department in Tianjin Cancer Hospital. Preoperative CEA tumor marker and postoperative EGFR gene mutation were used for routine detection. The influence of CEA tumor marker on EGFR mutation and its relationship with the prognosis were ana-lyzed further. Results：A total of 168 cases involved EGFR mutations, the incidence of which is more frequent in women, non-smokers, adenocarcinoma patients, and patients below 60 years old （P〈0.05）. This study also determined that EGFR mutation was related with tu-mor markers and chemosensitivity indicators. Elevated Cyfra21-1, SCC, and ERCC1-positive are more common in wild-type patients （P〈0.05）. However, abnormal CEA was more common in EGFR mutation patients （P=0.015）. The rate of EGFR gene mutations signifi-cantly increased as the serum CEA level increased. Serum CEA levels were divided into three groups （〈5, 5-20, and〉20）. The positive rates of EGFR mutations were 40.1%, 47.5%and 66.6%（P=0.003）. Logistic regression analysis determined that CEA levels are inde-pendent factors in predicting EGFR mutations and independent prognostic factors in patients with non-small cell lung cancer. Conclu-sion：Serum CEA levels can independently predict the prognosis of resected non-small cell lung cancer patients, which is has a close re-lationship with EGFR mutations.