基线血清铁蛋白水平对应用EGFR-TKIs的NSCLC患者预后的预测价值

Predictive Value of Baseline Serum Ferritin Level for the Prognosis of NSCLC Patients Treated with EGFR-TKIs

目的探讨血清铁蛋白(SF)水平对应用表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)的非小细胞肺癌(NSCLC)患者预后的预测价值。方法纳入2016年6月—2018年11月我院收治的接受EGFR-TKIs治疗的EGFR基因敏感性突变NSCLC患者69例,随访患者的预后情况,根据患者1年疾病进展情况分为进展组和无进展组,对比两组患者的临床资料,血清铁蛋白等相关指标水平,采用Cox回归方程分析影响患者疾病进展的危险因素;绘制受试者工作曲线(ROC),分析SF、癌胚抗原(CEA)等相关指标水平在早期评估EGFR-TKIs治疗NSCLC患者预后中的预测价值。结果随访截至2019年12月31日,无失访病例,69例患者1年疾病进展率为39.13%(27/69),中位无进展生存时间(PFS)为10.1(5.4~26.7)个月。据此分为进展组(27例)和无进展组(42例)。对比两组患者的临床资料,进展组鳞癌比例、血清CEA、SF水平、年龄均高于无进展组,差异具有统计学意义(P<0.05);多因素Cox回归分析显示,年龄≥65岁(HR=9.749)、CEA(HR=2.150)、SF(HR=1.030)是影响NSCLC患者预后的独立危险因素(P<0.05);ROC曲线显示,CEA、SF联合预测的ROC曲线下面积(AUC)为0.862,高于SF(AUC=0.695)及CEA(AUC=0.660),其中SF截点值为311.10μg·L-1,CEA截点值为6.315μg·L-1,联合诊断的敏感度为92.95%,特异度为78.57%。结论血清铁蛋白水平可作为早期预测应用EGFR-TKIs的NSCLC患者预后的良好指标,可指导临床治疗。

Objective To investigate the value of serum ferritin(SF)level in predicting the prognosis of non-small cell lung cancer(NSCLC)patients using epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs).Methods Sixty-nine NSCLC patients with EGFR gene-sensitive mutations who were treated with EGFR-TKIs in our hospital between June 2016 and November 2018 were included in this study.All patients were followed up,and they were divided into progression group and progression-free group according to the disease progression within one year.The clinical data,serum ferritin level and other related indicators of patients were compared between the two groups.The Cox regression equation was used to analyze the risk factors affecting the patient’s disease progression.Draw the receiver operating characteristic(ROC)curve and analyze the early predictive value of the levels of SF,carcinoembryonic antigen(CEA)and other related indicators for the prognosis of NSCLC patients with EGFR-TKIs treatment.Results The follow-up was completed until December 31,2019.No case was lost in the follow-up.For all patients,the 1-year disease progression rate was 39.13%(27/69),and the median progression-free survival time was 10.1(5.4~26.7)months.Based on this,they were divided into progression group(27 cases)and progression-free group(42 cases).The progression group had higher proportion of squamous cell carcinoma,higher levels of serum CEA and SF,and higher age than the progression-free group(P<0.05).Multivariate Cox regression equation analysis showed that age≥65 years(HR=9.749),CEA(HR=2.150),and SF(HR=1.030)were independent risk factors affecting the prognosis of NSCLC patients(P<0.05).The ROC curve showed that the CEA-SF joint predicted area under the curve(AUC)was 0.862,and it was bigger than that of single SF(AUC=0.695)or CEA(AUC=0.660).The SF cutoff value was 311.10μg·L-1 and the CEA cutoff value was 6.315μg·L-1.The sensitivity was 92.95%and the specificity was 78.57%for the CEA-SF combined diagnosis.Conclusion The serum ferritin level can be used as an early indicator to predict the prognosis of NSCLC patients with EGFR-TKIs and guide clinical treatment.