NSCLC颅内转移患者血清NSE、CEA、CYFRA21-水平变化与靶向治疗效果的相关性
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摘要
目的探讨非小细胞肺癌(NSCLC)颅内转移患者血清神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)以及细胞角蛋白19片段(CYFRA21-1)水平变化与靶向治疗效果的相关性。方法收集87例靶向治疗的NSCLC颅内转移患者的临床资料,分析不同疗效患者血NSE、CEA、CYFRA21-1浓度变化,研究治疗前后NSE、CEA、CYFRA21-1变化率对临床疗效的评估价值。结果 87例患者治疗后病情部分缓解39例,病情稳定32例,病情进展16例,治疗总有效率为44.83%。病情部分缓解患者治疗后NSE、CEA、CYFRA21-1水平显著降低,且低于病情稳定和病情进展患者(P<0.05)。取变化率NSE<29.1%、CEA<34.5%、CYFRA21-1<31.8%为截断点,三者判定治疗有效的敏感性分别为71.8%、66.7%、69.2%,特异性为79.2%、77.1%、72.9%。与单独检测相比,三项指标联合检测判断治疗有效的敏感性和阴性预测值明显升高(P<0.05),而特异性、准确度以及阳性预测值则无明显变化(P>0.05)。结论血清NSE、CEA、CYFRA21-1水平可作为评估NSCLC颅内转移患者临床治疗结果的参考依据。
Objective To investigate the correlation between changes of serum neuronspecific enolase(NSE), carcino-embryonic antigen(CEA), cytokeratin 19 fragment(CYFRA21-1) and targeted therapy in nonsmall cell lung cancer(NSCLC) patients with brain metastasis. Method The clinical data of 87 NSCLC patients with brain metastasis were collected. The changes of serum NSE, CEA, CYFRA21-1 were analyzed in patients with different therapeutic effect. The estimated values of NSE, CEA, CYFRA21-1 change rate on clinical effects were studied.Results There were 39 cases with partial response, 32 cases with stable disease, 16 cases with progressive disease in 87 NSCLC patients with brain metastasis and total clinical efficiency was 44.83%. After treatment, the levels of serum NSE, CEA, CYFRA21-1 in patients with partial response were significantly reduced, which were lower than those in patients with stable disease and progressive disease(P<0.05). Take change rates of NSE<29.1%,CEA<34.5%, CYFRA21-1<31.8% as cutoff point, the sensibilities of three indexes to determine treatment efficacy were 71.8%, 66.7%, 69.2% and specificities were 79.2%, 77.1%, 72.9%. Compared with individual tests, the sensibility and negative predictive value of parallel combination detection were significantly raised(P<0.05), while the specificity, accuracy and positive predictive value had no significant changes(P>0.05). Conclusion The monitoring of serum NSE, CEA, CYFRA21-1 can be used as reference to evaluate the therapeutic effect of NSCLC patients with brain metastasis.
Objective To investigate the correlation between changes of serum neuronspecific enolase(NSE), carcino-embryonic antigen(CEA), cytokeratin 19 fragment(CYFRA21-1) and targeted therapy in nonsmall cell lung cancer(NSCLC) patients with brain metastasis. Method The clinical data of 87 NSCLC patients with brain metastasis were collected. The changes of serum NSE, CEA, CYFRA21-1 were analyzed in patients with different therapeutic effect. The estimated values of NSE, CEA, CYFRA21-1 change rate on clinical effects were studied.Results There were 39 cases with partial response, 32 cases with stable disease, 16 cases with progressive disease in 87 NSCLC patients with brain metastasis and total clinical efficiency was 44.83%. After treatment, the levels of serum NSE, CEA, CYFRA21-1 in patients with partial response were significantly reduced, which were lower than those in patients with stable disease and progressive disease(P<0.05). Take change rates of NSE<29.1%,CEA<34.5%, CYFRA21-1<31.8% as cutoff point, the sensibilities of three indexes to determine treatment efficacy were 71.8%, 66.7%, 69.2% and specificities were 79.2%, 77.1%, 72.9%. Compared with individual tests, the sensibility and negative predictive value of parallel combination detection were significantly raised(P<0.05), while the specificity, accuracy and positive predictive value had no significant changes(P>0.05). Conclusion The monitoring of serum NSE, CEA, CYFRA21-1 can be used as reference to evaluate the therapeutic effect of NSCLC patients with brain metastasis.
引文
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[2]Ge M,Zhuang Y,Zhou X,et al.High probability and frequency of EGFR mutations in non-small cell lung cancer with brain metastases[J].J Neurooncol,2017,135(2):413-418.
[3]Guo N,Zhao Y,Zhang W,et al.MicroRNA-133a downregulated EGFR expression in human non-small cell lung cancer cells via AKT/ERK signaling[J].Oncol Lett,2018,16(5):6045-6050.
[4]Oya Y,Yoshida T,Uemura T,et al.Serum ProGRP and NSE levels predicting small cell lung cancer transformation in a patient with ALK rearrangement-positive non-small cell lung cancer:A case report[J].Oncol Lett,2018,16(4):4219-4222.
[5]Isaksson S,J?nsson P,Monsef N,et al.CA 19-9 and CA 125as potential predictors of disease recurrence in resectable lung adenocarcinoma[J].PLoS One,2017,12(10):e0186284.
[6]中华医学会.临床诊疗指南(肿瘤分册)[M].北京:人民卫生出版社,2005:99-107.
[7]Parums DV.Current status of targeted therapy in non-small cell lung cancer[J].Drugs Today(Barc),2014,50(7):503-525.
[8]Fernandes AW,Wu B,Turner RM.Brain metastases in nonsmall cell lung cancer patients on epidermal growth factor receptor tyrosine kinase inhibitors:symptom and economic burden[J].J Med Econ,2017,20(11):1136-1147.
[9]Inomata M,Hayashi R,Yamamoto A,et al.Plasma neuron-specific enolase level as a prognostic marker in patients with non-small cell lung cancer receiving gefitinib[J].Mol Clin Oncol,2015,3(4):802-806.
[10]Metro G,Baglivo S,Siggillino A,et al.Successful response to osimertinib rechallenge after intervening chemotherapy in an EGFRT790M-positive lung cancer patient[J].Clin Drug Investig,2018,38(10):983-987.
[11]McGrath AC,Sandhu G,Walpole E,et al.Survival outcomes in patients with non-small-cell lung cancer treated with erlotinib[J].Anticancer Drugs,2018,29(8):786-790.
[12]Bisagni A,Pagano M,Maramotti S,et al.Higher expression of miR-133b is associated with better efficacy of erlotinib as the second or third line in non-small cell lung cancer patients[J].PLoS One,2018,13(4):e0196350.
[13]Mollaoglu G,Jones A,Wait SJ,et al.The lineage-defining transcription factors SOX2 and NKX2-1 determine lung cancer cell fate and shape the tumor immune microenvironment[J].Immunity,2018,49(4):764-779.
[14]Xu L,Lina W,Xuejun Y.The diagnostic value of serum CEA,NSEand MMP-9 for on-small cell lung cancer[J].Open Med(Wars),2016,11(1):59-62.
[15]Tang H,Bai Y,Shen W,et al.Clinical significance of combined detection of interleukin-6 and tumour markers in lung cancer[J].Autoimmunity,2018,51(4):191-198.
[16]Tsoukalas N,Kostakis ID,Giaginis C,et al.Carcinoembryonic antigen and carbohydrate antigen 19-9 serum levels in non-small cell lung cancer[J].J BUON,2017,22(6):1390-1394.
[17]Tsuji T,Sakamori Y,Ozasa H,et al.Clinical impact of high serum hepatocyte growth factor in advanced non-small cell lung cancer[J].Oncotarget,2017,8(42):71805-71816.
[18]Shirasu H,Ono A,Omae K,et al.CYFRA 21-1 predicts the efficacy of nivolumab in patients with advanced lung adenocarcinoma[J].Tumour Biol,2018,40(2):1010428318760420.
[19]Takeuchi A,Oguri T,Sone K,et al.Predictive and prognostic value of CYFRA 21-1 for advanced non-small cell lung cancer treated with EGFR-TKIs[J].Anticancer Res,2017,37(10):5771-5776.