CYFRA21-1化疗前后变化早期评估进展期非小细胞肺癌化疗疗效的价值  

Early Predictive Evaluation of Chemotherapy Efficacy and Prognosis of Serum CYFRA21-1 Change Pre-and post-Chemotherapy in Patients with Advanced Non-Small Cell Lung Cancer

作　　者：赵同伟[1] 卢丽琴[1] 钦志泉[1] 袁国荣[1] 高亮[1] 陈永健[2] 孙馨[1] 陈韵[1] 

机构地区：[1]浙江省人民医院肿瘤一科,310014 [2]浙江省人民医院检验中心,310014

出　　处：《医学研究杂志》2012年第8期110-113,16,共5页Journal of Medical Research

摘　　要：目的本研究通过检测进展期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者1个周期化疗前后CY-FRA21-1水平变化来评价其在早期预评价影像学疾病控制(diease control,DC)和预后中的效能和价值,为早期确定是否需要调整治疗方案提供依据。方法检测46例NSCLC患者化疗前、1个周期化疗后血液中CYFRA21-1水平;应用受试者特种工作曲线来评价CYFRA21-1变化对化疗后影像学DC的预评价效能;探讨CYFRA21-1变化和预后的关系。结果 CYFRA21-1变化率预评价患者DC的ROC曲线下面积为0.796,当CYFRA21-1变化率为-16.6%时,敏感度和特异度分别为91.9%和77.8%。Logistitc多因素风险回归分析知CYFRA21-1变化是预评价DC的独立预评价因子(P<0.01)。单因素生存分析知CY-FRA21-1变化阳性的患者肿瘤无疾病进展时间(progression-free survival,PFS)明显长于阴性患者(中位值分别为5.84个月和1.21个月,P<0.01)。COX多因素风险回归模型进一步分析知CYFRA21-1变化(P>0.05)不是预测PFS的独立预后因子。结论在CYFRA21-1水平升高的进展期NSCLC患者中,1个周期化疗前后CYFRA21-1变化可以预评价影像学DC和预测PFS,这为早期确定是否调整治疗方案提供了依据,值的进一步研究。Objective To explore early predictive evaluation of radiological diease control（DC） and prognosis of CYFRA21 - 1 change pre - and post - chemotherapy of one cycle in patients with advanced non - small - cell lung cancer（NSCLC） ,which may help to early determine whether treatment protocols of the patients need to be modified. Methods The serum CYFRA21 - 1 levels in 46 patients with NSCLC of pre - and post - chemotherapy of one cycle were detected. Efficacy of CYFRA21 - 1 change in predictive evaluation of diease control（DC） was evaluated using receiver operating characteristic curve（ROC）. The correlation of CYFRA21 - 1 change and prog- nosis was explored,too. Results When the change rates of the CYFRA21 - 1 levels were used to predict DC of patients, the area of ROC curve was O. 796. And when the cut - point of the change rates of CYFRA21 - 1 levels was - 16.6% , the sensitivity and specificity were respectively 91.9% and 77.8%. Logistic muhiunivariate regression analysis confirmed that CYFRA21 - 1 change was an independent prediction factor in predictive evaluation of DC （ P 〈 0. 01 ）. Univariate survival analysis showed that the progression - free survival（PFS） of positive patients in CYFRA21 - 1 change was much longer than that of negative patients（ media PFS 5.84 months and 1.21 months re- spectively, P 〈0.01 ）. COX multivariate survival analysis showed that CYFRA21 -1 change wasn＇t an independent prognosis factor of prediction of PFS （ P 〉 0. 05 ） , but DC,loss of weight and chemotherapy cycles were all independent prognosis factors in NSCLC patients （ P 〈0.05）. Conclusion CYFRA21 - 1 change can predict evaluation of radiological DC and PFS in advanced NSCLC patients with in- creased CYFRA21 - 1 levels. It provides important message about modification of treatment protocols and is worth to be further explored.

关 键 词：非小细胞肺癌细胞角蛋白19片段 化疗疗效 预测因子 预后 

分 类 号：R734.2[医药卫生—肿瘤]