伴有EGFR突变的非小细胞肺癌血清CYFRA21-1和CEA水平与EGFR-TKIs的疗效关系

背景与目的表皮生长因子受体-酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitors, EGFR-TKIs）是EGFR基因突变晚期非小细胞癌（non-small cell lung cancer, NSCLC）患者一线标准治疗方案，但是临床实践中，疗效差异较大。本项实验拟研究治疗前血清细胞角蛋白19片段（cytokeratin-19 frag-ments, CYFAR21-1）和癌胚抗原（carcinoembryonic antigen, CEA）的水平是否与EGFR-TKIs疗效有关。方法回顾性分析194例EGFR基因突变阳性且接受EGFR-TKIs治疗的NSCLC患者的治疗前的血清CYFAR21-1和CEA水平与EGFR-TKIs疗效及生存时间的关系。结果血清水平CYFAR21-1增高和正常的无进展生存时间（progression-free survival, PFS）分别为7.0个月和11.9个月（P<0.001）；总生存（overall survival, OS）分别为12.6个月和28.0个月（P<0.001）。腺癌中，血清水平增高和正常的PFS分别为7.0个月和12.0个月（P<0.001），OS分别为13.1个月和28.1个月（P<0.001）。鳞癌中，血清CYFRA21-1水平高低与生存时间无关。治疗前血清CEA水平高低与生存时间无关。结论在EGFR突变肺腺癌患者，治疗前血清水平CYFAR21-1增高组EGFR-TKIs治疗的PFS和OS均较正常组短。EGFR突变肺腺癌患者，治疗前血清CYFAR21-1水平可以作为预测EGFR-TKIs治疗的疗效指标。

Serum CYFRA21-1 is Correlated with the Efifcacy of Epidermal Growth Factor Re-ceptor-tyrosine Kinase Inhibitor in Non-small Cell Lung Cancer Patients Harboring EGFR Mutations

Background and objectiveEpidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are the standard ifrst-line treatment regimen forEGFR mutated non-small cell lung cancer (NSCLC) patients. However, the ef-ifcacy of EGFR-TKIs widely varies. hTe aim of this study is to determine whether the pretreatment serum cytokeratin-19 frag-ments (CYFAR21-1) and carcinoembryonic antigen (CEA) are associated with the effcacy of EGFR-TKIs inEGFR-mutated NSCLC patients.MethodsWe retrospectively enrolled 194 NSCLC patients harboringEGFR mutations who received EGFR-TKIs. Clinical characteristics were collected, and the relation between the effcacy of EGFR-TKIs and pretreatment serum CYFAR21-1 and CEA was analyzed.Results In all cases, progression-free survival (PFS) in patients with high CYFAR21-1 level was signiifcantly shorter than PFS in patients with normal CYFAR21-1 (7.0vs 11.9 months,P<0.001). Overall survival (OS) in patients with high CYFAR21-1 was signiifcantly shorter than in the normal-CYFAR21-1 group (12.6vs28.0 months, P<0.001). In adenocarcinoma patients, PFS in the high-CYFAR21-1 level group was signiifcantly shorter than in patients with normal CYFAR21-1 (7.0vs 12.0 months,P<0.001). OS in patients with high CYFAR21-1 was signiifcantly shorter than that in the normal-CYFAR21-1 group (13.1vs 28.1 months,P<0.001). Among squamous carcinoma patients, CYFAR21-1 level did not affect survival. No signiifcant difference in PFS and OS was observed between patients with high CEA and patients with normal CEA.ConclusionEGFR-mutated patients with high CYFAR21-1 had signiifcantly shorter PFS and OS than patients with normal CYFAR21-1 atfer receiving EGFR-TKIs. Pretreatment serum CYFR21-1 level was a predictive marker of EGFR-TKI treatment inEGFR-mutated NSCLC patients.