血清细胞角蛋白19片段与晚期非小细胞肺癌患者化疗疗效及预后关系的研究

摘要

Objective: The comparison of pre - and post - chemotherapy serum CYFRA21 - 1 change level with radiological OR is made to explore which factors most closely related with the prognosis in advanced NSCLC patients. Methods: Using immunoradiometric kits to detect the pre - and post -chemotherapy serum CK - 19 level change of 112 NSCLC patients, and compared with radiological OR. Results: There were 80 patients who were evaluable for radiological and serological efficacy in 112 advanced NSCLC patients after 2 cycles of chemotherapy, 26.3% of the patients had objective response (OR) , 65.0% of the patients had disease control ratio (DCR). The median survival time of all patients were 9. 9 months. The median survival time of DCR and OR were similar (P =0. 094) , both longer than PD (all P <0. 001). The post — chemotherapy serum CK — 19 level decreasd significantly compared with pre — chemotherapy (P <0. 001 ) , which was accordant with chemotherapy efficacy. Serum CK - 19 decreasd ≥60% and ≥30% had better sensitivity and specificity on OR and DCR. Serum CYFRA21 —1 decrease ≥30% was highly related with DC (P< 0.001) and survival (P< 0.001). Multivariate analysis showed that serum CYFRA21 -1 decrease ≥30% (RR =0. 429,P =0. 002) and DCR(RR =0. 450,P =0. 017) were independent prognostic factors, there was no correlation between OR and survival time. Conclusion: DCR is better than OR for the evaluation and prediction of chemotherapy efficacy, CYFRA21 - 1 decrease ≥30% is a potential indicator for prediction the chemotherapy efficacy in advanced NSCLC patients.%目的:探讨晚期非小细胞肺癌( NSCLC)患者化疗前后血清细胞角蛋白19片段(CYFRA21-1)变化水平与影像学疗效哪个因素与预后的关系最密切.方法:采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水平变化,并将其变化水平与临床反应类型进行比较.结果:经过2个周期化疗后,112例患者中有80例可行影像学和血清学疗效评价,其中,影像学客观缓解率为26.3％,疾病控制率为65.0％.80例患者的中位生存期(MST)为9.9个月.影像学缓解(OR)与疾病控制(DC)患者的MST相似(P =0.094),但均长于PD患者(P均＜0.001).化疗后血清CYFRA21-1水平下降幅度与临床疗效相符.血清CYFRA21 -1水平下降幅度≥30％和≥60％对于诊断DC和OR有最佳灵敏度和特异度.血清CY-FRA21 -1水平下降幅度≥30％与DC(P ＜0.001)及生存期(P ＜0.001)密切相关.多因素分析表明,DC(RR=0.450,P=0.017)及血清CYFRA21 -1水平下降幅度≥30％( RR=0.429,P=0.002)是影响预后的独立因素,而OR与生存期无关.结论:DC较OR更适合作为判定NSCLC化疗疗效的指标,血清CYFRA21 -1水平下降幅度≥30％有望成为评价NSCLC化疗疗效的替代指标.