CEA、CA125、CYFRA21-1水平在EGFR-TKIs治疗EGFR突变阳性的非小细胞肺腺癌疗效评估中的临床价值

doi:10.3969/j.issn.1004-583X.2021.03.006

摘要/Abstract

摘要：

目的探讨表皮生长因子受体(EGFR)突变的肺腺癌患者血清癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角蛋白19片段抗原21-1(CYFRA21-1)水平与表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKIs)治疗效果的关系。方法选择我院收治的EGFR基因突变的晚期非小细胞肺癌(NSCLC)腺癌患者186例,均采用一代EGFR-TKIs治疗,分析治疗前CEA、CA125、CYFRA21-1水平与无进展生存期(PFS)、总生存期(OS)的关系。结果 186例接受EGFR-TKIs治疗的肺腺癌患者治疗后中位PFS与OS为8.8个月、22.9个月。CEA水平升高的肺腺癌患者中位PFS、OS(13.2个月,26.7个月)优于CEA水平正常患者(8.1个月,12.8个月),CA125水平升高患者中位PFS、OS(13.5个月,26.8个月)优于CA125水平正常患者(8.2个月,12.4个月),CYFRA21-1水平正常患者中位PFS、OS(12.8个月,25.8个月)优于CYFRA21-1水平升高患者(8.3个月,13.5个月)(P<0.05)。结论 EGFR突变肺腺癌患者CEA、CA125水平升高及CYFRA21-1水平正常是评价EGFR-TKIs疗效的正性预测因素。

关键词: 癌, 非小细胞肺, 腺癌, 表皮生长因子酪氨酸激酶抑制剂, 癌胚抗原, CA-125抗原, 预后

Abstract:

Objective To explore the relationship of treatment effects between the correlation of carcinoembryonic antigen(CEA), carbohydrate antigen 125(CA125), cytokeratin 19 fragment antigen 21-1(CYFRA21-1) level and clinical effect of epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs) for lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutation. Methods One hundred and eighty six patients with EGFR mutations of advanced non-small cell lung cancer(NSCLC) from our hospital were selected. The first generation of EGFR-TKIs was used for therapy, and the correlation between CEA, CA125, CYFRA21-1 level before treatment and progression-free survival(PFS), overall survival(OS) was analyzed. Results The median PFS and OS of 186 lung adenocarcinoma patients receiving EGFR-TKIs treatment after treatment were 8.8 months and 22.9 months respectively, and the median PFS and OS of lung adenocarcinoma patients with high CEA level (13.2 months, 26.7 months) were better than those of patients with normal CEA level (8.1 months, 12.8 months), the median PFS and OS of patients with elevated CA125 level (13.5 months, 26.8 months) were better than those of patients with normal CA125 level (8.2 months, 12.4 months), the median PFS and OS of patients with normal CYFRA21-1 level (12.8 months, 25.8 months) were better than those of patients with elevated CYFRA21-1 level (8.3 months, 13.5 months)(P<0.05). Conclusion It is positive predictors for evaluating the efficacy of EGFR-TKIs, that the elevated levels of CEA and CA125 and normal levels of CYFRA21-1 in patients with EGFR-mutant lung adenocarcinoma.

Key words: carcinoma, non-small-cell lung, lung adenocarcinoma, epidermal-growth factor receptor tyrosine kinase inhibitors, carcinoembryonic antigen, CA-125 Antigen, prognosis

中图分类号:

R730.26

何一文, 乔田奎. CEA、CA125、CYFRA21-1水平在EGFR-TKIs治疗EGFR突变阳性的非小细胞肺腺癌疗效评估中的临床价值[J]. 临床荟萃, 2021, 36(3): 220-224.

He Yiwen, Qiao Tiankui. Clinical value of CEA, CA125, and CYFRA21-1 levels in efficacy evaluation of EGFR-TKIs in the treatment of EGFR mutation-positive non-small cell lung adenocarcinoma[J]. Clinical Focus, 2021, 36(3): 220-224.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.03.006

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I3/220

图/表 10

参考文献 20

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项目	例数	中位PFS(月)	Z值	P值	中位OS(月)	Z值	P值
年龄(岁)
≤70 >70	158 28	8.9 10.3	0.793	0.489	22.8 23.9	0.821	0.437
性别
男女	79 107	10.7 8.5	0.877	0.413	23.7 22.0	0.363	0.816
PS评分
0~1 2~4	157 29	9.8 4.9	4.249	<0.01	23.7 9.4	5.824	<0.01
临床分期
Ⅲb Ⅳ	11 175	9.2 8.6	0.611	0.523	23.5 22.7	0.482	0.724
EGFR基因
19外显子缺失突变	107	8.8			23.7
21外显子错义突变	72	7.9	0.923	0.384	19.4	1.034	0.202
其他	7	9.3			20.2
EGFR-TKIs治疗
埃克替尼	109	8.9			20.8
吉非替尼	51	9.6	0.284	0.941	22.5	0.862	0.433
厄洛替尼	26	10.8			23.1
远处转移
是否	65 121	6.9 11.0	4.146	<0.01	13.8 25.9	4.724	<0.01
CEA水平(ng/ml)
≤5 >5	64 122	8.1 13.2	4.071	<0.01	12.8 26.7	5.643	<0.01
CA125水平(U/ml)
≤35 >35	57 129	8.2 13.5	3.954	<0.01	12.4 26.8	5.923	<0.01
CYFRA21-1(ng/ml)
≤3.3 >3.3	105 81	12.8 8.3	4.672	<0.01	25.8 13.5	5.028	<0.01

项目	例数	中位PFS(月)	Z值	P值	中位OS(月)	Z值	P值
年龄(岁)
≤70 >70	158 28	8.9 10.3	0.793	0.489	22.8 23.9	0.821	0.437
性别
男女	79 107	10.7 8.5	0.877	0.413	23.7 22.0	0.363	0.816
PS评分
0~1 2~4	157 29	9.8 4.9	4.249	<0.01	23.7 9.4	5.824	<0.01
临床分期
Ⅲb Ⅳ	11 175	9.2 8.6	0.611	0.523	23.5 22.7	0.482	0.724
EGFR基因
19外显子缺失突变	107	8.8			23.7
21外显子错义突变	72	7.9	0.923	0.384	19.4	1.034	0.202
其他	7	9.3			20.2
EGFR-TKIs治疗
埃克替尼	109	8.9			20.8
吉非替尼	51	9.6	0.284	0.941	22.5	0.862	0.433
厄洛替尼	26	10.8			23.1
远处转移
是否	65 121	6.9 11.0	4.146	<0.01	13.8 25.9	4.724	<0.01
CEA水平(ng/ml)
≤5 >5	64 122	8.1 13.2	4.071	<0.01	12.8 26.7	5.643	<0.01
CA125水平(U/ml)
≤35 >35	57 129	8.2 13.5	3.954	<0.01	12.4 26.8	5.923	<0.01
CYFRA21-1(ng/ml)
≤3.3 >3.3	105 81	12.8 8.3	4.672	<0.01	25.8 13.5	5.028	<0.01

变量	赋值	变量	赋值
年龄	≤70岁=0;>70=1	EGFR-TKIs治疗	埃克替尼=1;吉非替尼=2;厄洛替尼=3
性别	男=0;女=1	是否远处转移	否=0;是=1;
PS评分	0~1分=0;2~4分=1	CEA水平	≤5 ng/ml=0;>5 ng/ml=1
临床分期	Ⅲb=0;Ⅳ=1	CA125水平	≤35 U/ml=0;>35 U/ml=1
EGFR基因	19外显子缺失突变=1;21外显子错义突变=2;其他=3	CYFRA21-1水平	≤3.3 ng/ml=0;>3.3 ng/ml=1

变量	赋值	变量	赋值
年龄	≤70岁=0;>70=1	EGFR-TKIs治疗	埃克替尼=1;吉非替尼=2;厄洛替尼=3
性别	男=0;女=1	是否远处转移	否=0;是=1;
PS评分	0~1分=0;2~4分=1	CEA水平	≤5 ng/ml=0;>5 ng/ml=1
临床分期	Ⅲb=0;Ⅳ=1	CA125水平	≤35 U/ml=0;>35 U/ml=1
EGFR基因	19外显子缺失突变=1;21外显子错义突变=2;其他=3	CYFRA21-1水平	≤3.3 ng/ml=0;>3.3 ng/ml=1

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
PS评分(2~4分)	1.956	0.523	17.853	<0.01	5.753	2.538	9.838
CEA水平	-1.256	0.424	9.824	<0.01	3.964	1.163	5.637
CA125水平	-1.442	0.432	12.532	<0.01	4.234	1.545	5.853
CYFRA21-1水平	1.895	0.495	14.828	<0.01	4.533	1.824	7.725