血清癌胚抗原和CYFRA21-1预测晚期非小细胞肺癌患者化疗疗效及预后的价值研究

目的探讨化疗前后血清癌胚抗原(CEA)和细胞角蛋白19片段(CYFRA21-1)水平变化在预测晚期非小细胞肺癌(NSCLC)患者化疗疗效及预后方面的价值。方法应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和CEA水平,并将其变化水平与影像学疗效进行比较。结果化疗2个周期后可行影像学和血清学疗效评价的98例患者化疗有效率为26.5%。化疗后血清CEA和CYFRA21-1水平较化疗前明显下降,差异有统计学意义(P<0.001)。化疗2周期后血清CYFRA21-1和CEA水平分别下降≥60%和≥25%时评价影像学客观缓解(OR)有最佳的敏感度和特异度。化疗后血清CYFRA21-1水平下降≥60%与OR(P<0.001)和生存期(P<0.001)密切相关。血清CEA水平下降≥25%亦与OR(P<0.001)和生存期(P<0.001)密切相关。多因素分析表明,化疗后血清CYFRA21-1水平下降≥60%和CEA水平下降≥25%是影响预后生存期的独立因素,而OR与预后无关。结论化疗2周期后血清CYFRA21-1水平下降≥60%和/或CEA水平下降≥25%有可能成为评价晚期NSCLC患者化疗效果较好的替代指标。

Clinical Value of Serum CEA and CYFRA21-1 in Prediction of Chemotherapy Efficacy and Prognosis in Patients with Advanced Non-Small Cell Lung Cancer

Objective To investigate the value of carcinoembryonic antigen(CEA) and serum cytokeratin 19 fragment(CK-19,CYFRA21-1) in predicting chemotherapy response and prognosis through their changes between pre-and post-chemotherapy in patients with advanced non-small cell lung cancer(NSCLC).Methods The electrochemiluminescence immunoassay(ECLIA) was used to determine the levels of serum CYFRA21-1 and CEA of 112 patients with advanced NSCLC before and after chemotherapy,and the results were compared with those of imaging examination.Results After two cycles of combined chemotherapy,98 patients were assessable for imaging and serologic efficacy evaluation,and the total effective rate was 26.5%.Post-chemotherapy serum CYFRA21-1 and CEA levels significantly decreased compared with baseline levels(P<0.001).Serum CYFRA21-1 decrease ratio ≥60% and CEA decrease ratio ≥25% had best sensitivity and specificity on evaluation of overall response(OR) in imaging feature.Serum CYFRA21-1 decrease ratio ≥60% had a significant correlation with OR(P<0.001) and survival(P<0.001).Serum CEA decrease ratio ≥25% also had a significant correlation with imaging OR(P<0.001) and survival(P<0.001).Multivariate analysis showed that serum CYFRA21-1 decrease ratio ≥60% and CEA decrease ratio ≥25% were independent prognostic factors of survival.However,imaging OR was not a prognostic factors of survival.Conclusion Serum CYFRA21-1 decrease ratio ≥60% and CEA decrease ratio ≥25% may be taken as a better reliable index for evaluating the efficacy of chemotherapy in patients with advanced NSCLC.