非小细胞肺癌化疗后血清标志物及相关指标改变及意义

Changes in and significance of serum markers and related indicators in patients with non-small cell lung cancer after chemotherapy

目的研究非小细胞化疗后效果和血清标志物及相关指标改变。方法回顾性分析2015年1月-2018年12月162例患者临床资料。检测患者化疗前后血清标志物和PCT/CT检查并进行评估。利用PCR扩增EGFR,并进行测序。收集患者性别、年龄、吸烟史、TNM分期、ECOG评分和EGFR外显子状态分析其疗效的相关性。结果 162例患者治疗3个周期后临床情况为:5例患者完全缓解、97例患者部分缓解、51例患者稳定、9例患者疾病进展,客观缓解率62.96%,疾病控制率94.44%。治疗期间有27例患者出现皮疹、23例患者出现恶心呕吐、22例患者出现腹泻、9例患者出现便秘、12例患者出现ALT和(或)AST升高、6例患者出现骨髓抑制、和3例患者出现间质性肺炎。77例患者标本的EGFR基因发生错义基因突变,突变率47.53%。其中58例发生单位点突变,19例患者双位点突变。主要形式为:19号外显子缺失,20号外显子发生T790M和21号外显子发生L858R突变。化疗前血清标志物CEA(25.9±3.3)ng/ml,VEGF(762.4±32.6)ng/L,NSE(20.5±8.6)ng/ml和CYFRA21-1(5.2±1.5)ng/ml;化疗前肿瘤直径(2.75±1.06)cm和SUVmax(4.82±2.71)。化疗后CEA(14.1±2.6)ng/ml,VEGF(316.5±29.8)ng/L,NSE(16.2±7.1)ng/ml和CYFRA21-1(3.7±1.3)ng/ml;化疗后肿瘤直径(1.98±0.91)cm和SUVmax(2.02±0.98)。非小细胞化疗疗效与性别、TNM分期、外显子19号突变和外显子21号突变差异无统计学意义(P>0.05),与年龄、ECOG评分和外显子20号突变差异有统计学意义(P<0.05)。结论肿瘤靶向治疗对非小细胞肺癌具有较好的治疗效果,靶基因位点突变可能导致肿瘤对药物产生耐受性。化疗前后血清标志物和SUV值均有变化,对于治疗效果具有良好的评价作用。

Objectives To study the effect of non-small cell lung cancer chemotherapy and changes in serum markers and related indicators. Methods Clinical data on 162 patients from January 2015 to December 2018 were analyzed retrospectively. Result After three cycles of treatment, the clinical condition of the 162 patients was as follows: 5 patients had CR, 97 had PR, 51 had SD, and 9 had PD. The ORR was 62.96 and DCR was 94.44%. During the treatment period, 27 patients had a rash, 23 had nausea and vomiting, 22 had diarrhea, 9 had constipation, 12 had elevated ALT and/or AST, 6 had myelosuppression, and 3 had interstitial pneumonia. The rate of mutation of the EGFR gene was 47.53% in 77 patients. Of those patients, 58 had a single point mutation and 19 had double mutations. The main forms were: exon 19 deletion, exon 20 T790 M mutation, and exon 21 L858 R mutation. Serum markers before chemotherapy were a CEA level of 25.9+3.3 ng/ml, a VEGF level of 762.4+32.6 ng/L, an NSE level of 20.5+8.6 ng/ml, and a CYFRA21-1 level of 5.2+1.5 ng/ml;tumor diameter was 2.75+1.06 cm and SUVmax was 4.82+2.71 before chemotherapy. Serum markers after chemotherapy were a CEA level of 14.1+2.6 ng/ml, a VEGF level of 316.5+29.8 ng/L, an NSE level of 16.2+7.1 ng/ml, and a CYFRA21-1 level of 3.7+1.3 ng/ml;tumor diameter was 1.98+0.91 cm and SUVmax was 2.02+0.98 after chemotherapy. The efficacy of non-small cell chemotherapy did not differ significantly by sex, TNM stage, exon 19 mutation, or exon 21 mutation(P>0.05), but it did differ significantly by age, ECOG score, and exon 20 mutation(P<0.05). Conclusion Tumor-targeting therapy is efficacious against non-small cell lung cancer. Target gene mutation may lead to tumors developing drug tolerance. Serum markers and SUV values changed before and after chemotherapy and satisfactorily indicated the efficacy of treatment.