血清CEA对EGFR突变晚期肺腺癌TKIs治疗疗效及生存的预测意义  

Predictive Value of Serum CEA for Efficacy and Prognosis of EGFR Mutant Advanced Lung Adenocarcinoma Treated with TKIs

作　　者：农靖颖[1] 王敬慧[1] 杨新杰[1] 吕嘉林[1] 吴羽华[1] 张树才[1] 

机构地区：[1]首都医科大学附属北京胸科医院肿瘤内科,北京101149

出　　处：《结核病与胸部肿瘤》2015年第2期105-110,共6页Tuberculosis and Thoracic Tumor

摘　　要：目的探讨治疗前血清癌胚抗原（CEA）对表皮生长因子受体（EGFR）突变的晚期肺腺癌患者接受酪氨酸激酶抑制剂（TKIs）治疗疗效及生存的影响。方法回顾性分析首都医科大学附属北京胸科医院肿瘤内科2005年12月至2013年4月接受吉非替尼、厄洛替尼或盐酸埃克替尼治疗的120例EGFR突变晚期肺腺癌患者的临床资料，评价TKIs治疗疗效并分析影响患者预后的因素。根据实体瘤疗效评价标准1．1版（RECIST1．1）评价近期疗效，Kaplan—Meier法进行生存分析，Cox风险比例模型分析影响预后的因素。结果全组患者接受EGFR-TKIs治疗的有效率（RR）为57．5％，疾病控制率（DCR）为94．2％。全组患者的中位无进展生存期（PFS）为9．0个月（95％CI：7．91～10．09个月），中位生存时间（OS）为23．5个月（95％CI：17．89～29．11个月）。治疗前血清CEA≥5ng／ml者（n=53）和CEA〈5ng／ml者（n=67）的RR分别为60．4％、55．2％（P〉0．05）；两组患者的中位PFS分别为8．0个月、10．0个月（P〉0．05），中位OS分别为17．2个月、30．0个月（P=0．022）。Cox多因素分析显示，吸烟状况、血清CEA水平及PS评分是影响肺腺癌OS的独立因素。结论ECFR突变的肺腺癌患者中，治疗前血清CEA水平不影响TKIs治疗的疗效，但CEA〈5ng／ml者的预后更好，尚有待前瞻性研究进一步证实。Objective To investigate the effects of pre-treatment serum carcinoembryonic antigen（CEA）on the efficacy and survival of tyrosine kinase inhibitors （TKIs） in the EGFR-mutant patients with advanced lung adenocarcinoma. Methods The clinical data of 120 patients with EGFR mutant advanced lung adenocarcinoma treated with gefitinib, erlotinib or icotinib hydrochloride at our department between December 2005 and April 2013 were retrospectively reviewed, and influencing factors of response and survival were analyzed. Differences in efficacy between variables were evaluated using the Response Evaluation Criteria in Solid TumoTs（RECIST） （version 1.1）. Progression free survival（PFS）and overall survival（OS） were estimated by the Kaplan-Meier method. Independent risk factors were assessed in multivariate analysis using the Cox proportional hazards model. Results The response rate（RR） and disease control rate （DCR） were 57.5% and 94.2%, respectively, the median PFS was 9.0 months（95%CI：7.91-10.09 months） and median OS was 23.5 months（95%CI：17.89-29.11 months）. The pre-treatment serum CEA level was positive （ ≥ 5 ng/ml） for 44.2% of the patients.Neither the RR to TKIs （55.2% vs. 60.4%, P=0.5721） nor PFS（10.0 months vs. 8.0 months, P〉0.05） had significant differences between the two groups of CEA〈5ng/ml and CEA ≥ 5 ng/ml. The median OS of patients with CEA〈5 ng/ml was significantly better （30.0 months vs. 17.2months, P=0.022）. A multivariate analysis indicated smoking, serum CEA and PS performance scoring to be independent prognostic factors. Conclusion It shows that the serum CEA〈5 ng/ml may not be a predictive factor for the efficacy of EGFR-TKIs, but it is a positive prognostic factor for EGFR mutant advanced lung adenocarcinoma patients undergoing this treatment.

关 键 词：肺腺癌 酪氨酸激酶抑制剂(TKIs) 表皮生长因子受体(EGFR)突变 癌胚抗原(CEA) 疗效 生存 

分 类 号：R734.2[医药卫生—肿瘤]