Serum Albumin And CEA Are Associated With Prognosis Of EGFR-TKI Treatment In Advanced Non-small Cell Lung Cancer With Sensitive EGFR Mutation

Objective:The prognostic and predictive value of serum albumin and carcinoembryonic antigen(CEA)were assessed in advanced non-small cell lung cancer(NSCLC)with sensitive EGFR mutation patients treated with first-line of epidermal growth factor receptor(EGFR)tyrosine kinase inhibitor(TKI).Methods:Clinical datas of 122 patients with advanced NSCLC who were sensitive EGFR mutation(19 exon deletion and 21 exon L858R/L861Q mutation)treated with first-line of gefitinib or erlotinib who were diagnosed by histopathology or cytopathology in Shanxi Tumor Hospital between October 2013 to October 2016 were analyzed.Serum albumin and CEA were measured was performed before the initiation ofgefitinib or erlotinib,and patients survival were acquired by phone or outpatient follw-up.The relationship between patients serum albumin and CEA level with clinical features and its oral EGFR-TKI treatment prognostic was analyzed.Results:1.Serum albumin of advanced NSCLC patients with sensitive EGFR mutation were related with age,albumin(<35g/L)were significantly more prevalent in patients with age≥65 years(?~2=5.043,P=0.025);Serum CEA of advanced NSCLC patients with sensitive EGFR mutation were related with smorking history and brain metastasis status,CEA level(≥5ng/ml)were significantly more prevalent in patients with smorking and brain metastasis(?~2 value were 4.966,8.660,7.945 respectively,P were 0.026,0.003,0.005respectively).2.Further analysis showed that serum CEA level in patients with brain metastases were significantly higher than non-brain metastases(15.16ng/ml vs 4.93ng/ml,t=3.851,P=0.001),and increased serum CEA level led to increased brain metastasis rate(?~2=14.351,P=0.001).The areas of CEA under the curve were 0.752(95%CI:0.666-0.826,P<0.05),when the serum CEA level was defined as the boundary value of 5ng/ml,the sensitivity was 66.67%and the specificity was 63.04%,suggested that the occurrence of brain metastases can be predicted by observing the serum CEA level before EGFR-TKI treatment.3.Kaplan-Meier survival curve showed that patients with normal albumin(≥35g/L),CEA level(<5ng/ml)and non-brain metastasis had significantly longer PFS(P<0.05),and normal albumin(≥35g/L),normal albumin CEA level(<5ng/ml)and good ECOG PS(0-1)had significantly longer OS(P<0.05).4.COX regression analysis showed that presence of serum albumin,CEA level and brain metastasis status were independent factors of PFS;serum albumin,CEA level and ECOG PS score were independent factor of OS.Conclusion:1.Serum albumin and CEA may be used as prognostic indicators for treated with first-line of EGFR-TKI drugs in advanced NSCLC patients with sensitive EGFR mutation;albumin level(<35g/L)and CEA level(≥5ng/ml)may be prognostic and predictive serum markers for poor survival in advanced NSCLC patients with sensitive EGFR mutation receiving first-line of gefitinib or erlotinib.2.Serum CEA level may have some reference value in the occurrence of brain metastases in advanced NSCLC patients with sensitive EGFR mutation.3.The brain metastasis status and ECOG PS score may be of significance for the prognosis of advanced NSCLC patients with sensitive EGFR mutation.