第1周期化疗前后CEA变化早期评价晚期NSCLC疗效和预后的意义  

Early Predictive Evaluation of Chemotherapy Effiicacy and Prognosis of Serum CEA 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] 丁忠祥[2] 袁国荣[1] 高亮[1] 陈永健[3] 孙馨[1] 陈韵[1] 

机构地区：[1]浙江省人民医院肿瘤科,310014 [2]浙江省人民医院放射科,310014 [3]浙江省人民医院检验中心,310014

出　　处：《医学研究杂志》2013年第2期151-155,共5页Journal of Medical Research

摘　　要：目的本研究通过分析晚期NSCLC患者第1周期化疗前后CEA的变化来研究其在早期评价影像学肿瘤疾病控制(disease control,DC)的效能和预后的价值,为早期检出进展(progressive disease,PD)患者,及时中止无效化疗方案提供依据。方法回顾性分析56例NSCLC患者化疗前、第1周期化疗后血液中CEA变化;应用受试者工作特征曲线(receiver operating characteristics curve,ROC)来评价CEA变化对于化疗后影像学DC的早期评价效能;探讨CEA变化和预后的关系。结果 CEA变化率早期评价患者DC的ROC曲线下面积为0.850,当CEA变化率为-12.8%时,敏感度达80.4%,特异性为90.0%。Logis-titc二元风险回归分析知CEA变化是早期评价DC的独立评价因子(P<0.01)。单因素分析知CEA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(中位值分别是6.44个月和2.67个月,P<0.05),但生存期(overall survival,OS)两组没有差异(P>0.05)。COX多因素风险回归模型进一步分析知CEA变化也是预测PFS的独立预后因子(P<0.05)。化疗周期数、体重变化是预测PFS和OS的独立预后因子(P<0.01)。结论在CEA水平升高的晚期NSCLC患者中,第1周期化疗前后CEA变化可以早期评价影像学DC和预测PFS,CEA变化可作为影像学评价的重要辅助工具,有利于个体化治疗。Objective To explore early predictive evaluation of radiological disease control （DC） and prognosis of CEA change pre - and post - chemotherapy of one cycle in patients with advanced non - small cell lung cancer（ NSCLC）. It may help to provide evidence on early detecting PD patients and pausing useless chemotherapy regimems in time. Methods The changes of serum CEA levels in 56 patients with NSCLC pre - and post - chemotherapy of one cycle were retrospectively investigated. Receiver operating characteristic curve （ROC） was used in evaluation of efficacy of CEA change in predictive evaluation of disease control. The correlation of CEA change and prognosis was exploed also. Results When the change rates of the CEA levels were used to predict DC of patients, the area of ROC curve was 0. 850. And when the cut - point of the change rates of CEA levels was - 12.8% , the sensitivity and specificity were respec- tively 80.4% and 90.0%. Binary logistic regression analysis confirmed that CEA change was an independent prediction factor in predic- tive evaluation of DC（ P 〈 0. 01 ）. Univariate survival analysis showed that the progression- free survival （PFS） of positive patients in CEA change was much longer than the one of negative patients（ media PFS 6.44 months and 2.76 months respectively, P 〈 0.05 ） , but there was no difference in overal survival（OS） （P 〉 0. 05）. Multivariate survival analysis showed that CEA change was also an independ- ent prognosis factor of prediction of PFS （ P 〈 0.05 ）. The chemotherapy cycles and loss of weight were all independent prognosis factors in both PFS and OS among NSCLC patients（P 〈 0.01 ）. Conclusion CEA change can earlily predict evaluation of DC and PFS in advanced NSCLC patients with increased CEA levels. It was proven to be the important auxiliary tool of radiological evaluation and is in favour of in- dividual therapy.

关 键 词：非小细胞肺癌 癌胚抗原 化疗疗效 预测因子 预后 

分 类 号：R734.2[医药卫生—肿瘤]