肿瘤标志物与非小细胞肺癌脑转移的相关性

Relationship between serum tumor markers and brain metastasis in patients with advanced non-small cell lung cancer

目的:探讨血清CEA、CA125、CA153、CA199、CA724和CYFRA21-1水平与晚期非小细胞肺癌(NSCLC)脑转移发生和预后的相关性。方法:回顾性分析我院2009年4月至2013年10月289例(非脑转移223例,脑转移66例)未进行过任何治疗的Ⅳ期NSCLC患者临床资料。结果:全组病例脑转移发生率为22.8%(66/289),66例脑转移的中位生存期为9.4个月,1年、2年生存率分别为37%、15%。高表达患者的血清CEA水平与脑转移发生相关,无脑转移和脑转移患者血清CEA中位数分别为6.8ng/ml、16.0ng/ml(P=0.001)。血清CEA≤5ng/ml者比CEA>5ng/ml者预后好,中位生存时间分别为1 5个月和8个月(P=0.027);与血清CA125≤35ng/ml相比,血清CA125>35ng/ml预后差,两者中位生存时间分别为13个月和7个月(P=0.008)。多因素显示血清CA125水平、是否放疗和性别是影响NSCLC脑转移生存预后的独立因素。结论:高表达的血清CEA水平可预测NSCLC脑转移发生;血清CA125水平是影响NSCLC脑转移患者预后的独立因素。

Objective：To explore the relationship between serum tumor markers and brain metastasis in patients with advanced non - small cell lung cancer（NSCLC）. Methods：The clinical data of 289 advanced NSCLC patients hospitalized from April 2009 to October 2013 were retrospectively analyzed. All the enrolled patients were newly diag-nosed NSCLC with stage Ⅳ and not received treatment previously. Of those patients,223 had no brain metastasis. The rest were diagnosed with brain metastasis. Results：The incidence of brain metastasis was 22. 8%（66 / 289）,the medi-an survival time of patients with the brain metastasis was 9. 4 months. The 1 - year and 2 - year survival rates were 37% and 15% respectively. The serum level of carcinoembryonic antigen（CEA）was significantly different between no brain metastasis patients and those who had（P = 0. 001）. The median value of CEA of patients with and without brain metastasis was 6. 8ng/ ml,16. 0ng/ ml respectively. Overall survival was significantly shorter among patients with elevated serum CEA（median survival 15 months vs. 8 months,P = 0. 027）or CA125（median survival 13 months vs. 7 months,P = 0. 008）. In multivariate analysis,CA125,radiotherapy and sex were independent prognostic factors for brain metastasis（P 〈 0. 05）. Conclusion：The high serum CEA level may be potentially used as an indicator to predict the probability of brain metastasis in patients with NSCLC. The high serum CA125 may be used as reference index of the prognosis of brain metastasis in patients with NSCLC.