血清CEA水平在EGFR-TKI治疗非小细胞肺癌的应用价值

The value of carcinoembryonic antigen levels in non-small cell lung cancer patients treated with EGFR-TKI

目的：探讨血清癌胚抗原（carcino-embryonic antigen,CEA）在表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗非小细胞肺癌的价值,方法：回顾性收集确诊非小细胞肺癌并使用EGFR-TKI治疗患者的治疗前后CEA水平、一般资料、病理亚型、分期、分子标记物和CEA对治疗决策的影响,并定期影像学评价,随访至进展生存期（progression-free survival,PFS）和总生存期（overall survival,OS）。通过Kaplan-Meier绘制生存曲线,log-rank检验比较不同CEA组间的生存差异,Cox回归分析预后因子。结果：本研究纳入2002年6月至2011年8月广东省肺癌研究所使用EGFRTKI的非小细胞肺癌患者209例。分为3组：L组（CEA≤5,n=54）,M组（520,n=103）。L组、M组和H组的中位PFS分别为19、17和13月（95%CI,14.61-19.39;P=0.018）;中位OS分别为32、31和24月（95%CI,25.14-30.86;P=0.010）。治疗前低CEA的患者有显著延长的PFS和OS。CEA升高同时伴有影像学进展的45例,CEA升高无影像学进展证据的27例,两组的中位PFS分别为13月和14月（95%CI,10.51-15.49,P=0.195）;中位OS分别为23月和28月（95%CI,19.81-30.19,P=0.156）。CEA升高无影像学进展的27例患者均随访至进展才改变治疗策略,中位无进展时间为24.3月（3-111月）。结论：治疗前血清CEA水平和EGFR-TKI治疗晚期非小细胞肺癌的预后呈负相关;治疗过程中CEA升高时,需结合影像学和症状来决定是否改变治疗策略。

Objective： The value of serum levels of carcinoembryonic antigen （CEA） were evaluated in non-small cell lung cancer （NSCLC） patients treated with gefitinib or erlotinib. Methods： Patient characteristics, histological and molecular profiles of advanced lung cancer patients who receiving gefitinib or erlotinib were retrospectively collected. Progression-free survival （PFS） and overall survival （OS） were evaluated by Kaplan-Meier and Cox regression models. Results： From June 2002 to August 2011, 209 patients with pathologically confirmed locally advanced or metastatic NSCLC were enrolled into the study at Guangdong General Hospital （GGH）. Patients in this study were retrospectively categorized into 3 groups as： group L （CEA~〈 5, n=54）, group M （5〈CEA≤ 20, n=52） and group H （CEA〉20, n=103）. The median PFS of group L, group M and group H was 19, 17 and 13 months （95% CI, 14.61-19.39; P=0.018）; and the median OS of group L, group M and group H was 32, 31 and 24 months （95% CI, 25.14-30.86; P=0.010）; the difference was statistically significant. Patients with low- CEA had significantly longer PFS and OS. Elevated CEA with imaging finding progression at the same time in 45 cases, elevated CEA without imaging finding progression in 27 cases, the median PFS of two groups were 13 and 14 months （95% CI, 10.51-15.49; P=0.195）; the median OS was 23 and 28 months （95% CI, 19.81-30.19; P=0.156）. The patients of elevated CEA without imaging progression had a median PFS of 24.3 months （3 to 111 months）. Conclusion： Pretreatment serum levels of CEA can serve as predictive and prognostic factor for advanced NSCLC patients treated with EGFR TKIs. CEA may be an alternative and useful indicator of treatment response. When CEA increased, imaging and symptoms should be also considered to determine treatment strategy