Prognostic Value of Chemo-Naïve Serum Carcinoembryonic Antigen Level in Patients with Non-Small-Cell Lung Cancer

血清癌胚抗原在未接受化學治療的非小細胞肺癌患者之預測價值

高旭卿(Hsu-Ching Kao) ； 張晃智(Huang-Chih Chang) ； 林孟志(Meng-Chih Lin) ； 方文豐(Wen-Feng Fang) ； 黃國棟(Kuo-Tung Huang) ； 曾嘉成(Chia-Chen Tseng) ； 劉世豐(Shih-Feng Liu) ； 王金洲(Chin-Chou Wang)

《胸腔醫學》 29卷4期 (2014/08) Pp. 200-208

摘要

背景：癌胚抗原（CEA）是一個已知的非小細胞肺癌（NSCLC）的標記。而在一些針對非小細胞肺癌患者中的小樣本研究中發現，癌胚抗原是這些患者死亡率和預後不良的一個危險因素。本研究目的是評估血清癌胚抗原值，在不同腫瘤分期且未接受化學治療，且較大樣本數的非小細胞肺癌患者中之預測價值。方法：251位患有第2期至第4期非小細胞肺癌者，其血清癌胚抗原值在接受化療前接受測量。之後251位患者於2008/01 to 2011/12期間，在高雄長庚紀念醫院接受cisplatin and gemcitabine的第一線化學治療。這些病人被分為兩組：一組其血清癌胚抗原值在接受化療前大於等於40 ng/mL，另一組血清癌胚抗原值小於40 ng/mL。我們分析此兩組病人在臨床特徵，總生存率，以及2年死亡率之差異。另外，我們也檢視血清癌胚抗原值與癌症轉移部位之關聯性。結果：在251個患者中，183位（72.9%）其血清癌胚抗原值小於40 ng/mL，68位（27.1%）血清癌胚抗原值大於等於40 ng/mL。單變項分析發現肺腺癌（p=0.014），後期肺癌（p=0.007），以及癌細胞轉移（p=0.037）與血清癌胚抗原值大於或於40 ng/mL有關。Cox多變項回歸分析結果顯示病人體能狀態，癌症分期，以及患者年齡大於等於70歲為非小細胞肺癌患者死亡的獨立預測因子。血清癌胚抗原值並非患者死亡與否的預測因子，也無法預測IIIb期患者之後癌症轉移部位。結論：在此研究中，血清癌胚抗原不是非小細胞肺癌患者死亡的預測因子。

關鍵字

非小細胞肺癌 ； 血清癌胚抗原 ； 死亡 ； 預測因子

並列摘要

Background: Carcinoembryonic antigen (CEA) is a known marker for non-small cell lung cancer (NSCLC) and was suggested as a risk factor for mortality and poor prognosis in some studies of a small sample size involving patients in early and advanced stages of NSCLC. The aim of this study was to assess the prognostic value of the serum CEA level in a larger chemo-naïve patient population with NSCLC of different stages. Methods: Two hundred fifty-one (251) patients with stage II to IV NSCLC had their serum CEA measured before chemotherapy, and then received cisplatin and gemcitabine as first-line chemotherapy at Kaohsiung Chang Gung Memorial Hospital from 2008/01 to 2011/12. Patients were subdivided into 2 groups: pre-chemotherapy serum CEA level ≥40 ng/ml and ＜40 ng/ml. We analyzed the difference in clinical characteristics, overall survival, and 2-year mortality between the 2 groups. We also examined the association between the serum CEA level and the sites of metastasis. Results: Of the 251 patients with NSCLC, 183 (72.9%) had a serum CEA level ＜40 ng/mL and 68 (27.1%) had a CEA level ≥40 ng/mL. Univariate analysis showed adenocarcinoma (p=0.014), advanced staging (p=0.007), and metastasis (p=0.037) were associated with CEA ≥40 ng/ml. Multivariate Cox regression analysis showed that performance status (AHR 3.49; 95% CI, 1.81-6.72; p=0.000), staging (AHR 5.37; 95% CI, 1.94-14.82; p=0.001) and age ≥70 (AHR 1.84; 95% CI, 1.02-3.24; p=0.044) were prognostic factors for mortality in patients with NSCLC. The serum CEA level was not a prognostic factor for mortality, nor did it predict the site of metastasis in patients with stage IIIb NSCLC. Conclusions: Serum CEA level was not a prognostic factor for mortality in patients with NSCLC in our study.

並列關鍵字

non-small cell lung cancer ； carcinoembryonic antigen (CEA) ； mortality ； predictor