血清细胞角蛋白19片段与晚期非小细胞肺癌患者化疗疗效及预后关系的研究

目的:探讨晚期非小细胞肺癌(NSCLC)患者化疗前后血清细胞角蛋白19片段(CYFRA21-1)变化水平与影像学疗效哪个因素与预后的关系最密切。方法:采用电化学发光免疫法检测112例晚期NSCLC患者化疗前后血清CYFRA21-1水平变化,并将其变化水平与临床反应类型进行比较。结果:经过2个周期化疗后,112例患者中有80例可行影像学和血清学疗效评价,其中,影像学客观缓解率为26.3%,疾病控制率为65.0%。80例患者的中位生存期(MST)为9.9个月。影像学缓解(OR)与疾病控制(DC)患者的MST相似(P=0.094),但均长于PD患者(P均<0.001)。化疗后血清CYFRA21-1水平下降幅度与临床疗效相符。血清CYFRA21-1水平下降幅度≥30%和≥60%对于诊断DC和OR有最佳灵敏度和特异度。血清CY-FRA21-1水平下降幅度≥30%与DC(P<0.001)及生存期(P<0.001)密切相关。多因素分析表明,DC(RR=0.450,P=0.017)及血清CYFRA21-1水平下降幅度≥30%(RR=0.429,P=0.002)是影响预后的独立因素,而OR与生存期无关。结论:DC较OR更适合作为判定NSCLC化疗疗效的指标,血清CYFRA21-1水平下降幅度≥30%有望成为评价NSCLC化疗疗效的替代指标。

Correlation between serum cytokeratin 19 fragment and chemotherapy efficacy and prognosis in the patients with advanced non -small cell lung cancer

Objective:The comparison of pre-and post-chemotherapy serum CYFRA21-1 change level with radiological OR is made to explore which factors most closely related with the prognosis in advanced NSCLC patients.Methods: Using immunoradiometric kits to detect the pre-and post-chemotherapy serum CK-19 level change of 112 NSCLC patients,and compared with radiological OR.Results: There were 80 patients who were evaluable for radiological and serological efficacy in 112 advanced NSCLC patients after 2 cycles of chemotherapy,26.3% of the patients had objective response(OR),65.0% of the patients had disease control ratio(DCR).The median survival time of all patients were 9.9 months.The median survival time of DCR and OR were similar(P=0.094),both longer than PD(all P<0.001).The post-chemotherapy serum CK-19 level decreasd significantly compared with pre-chemotherapy(P<0.001),which was accordant with chemotherapy efficacy.Serum CK-19 decreasd ≥60% and ≥30% had better sensitivity and specificity on OR and DCR.Serum CYFRA21-1 decrease ≥30% was highly related with DC(P<0.001) and survival(P<0.001).Multivariate analysis showed that serum CYFRA21-1 decrease ≥30%(RR=0.429,P=0.002) and DCR(RR=0.450,P=0.017)were independent prognostic factors,there was no correlation between OR and survival time.Conclusion: DCR is better than OR for the evaluation and prediction of chemotherapy efficacy,CYFRA21-1 decrease ≥30% is a potential indicator for prediction the chemotherapy efficacy in advanced NSCLC patients.