| Background and PurposeLung cancer, account for the first place within male cancer patients, is the first cause of cancer related death in the world. Non-small cell lung cancer (NSCLC) takes up80%of all lung cancer cases while the5year survival rate is lower than15%. Central nervous system (CNS) is the most common sites where metastasis takes place, which takes up20%-30%of NSCLC metastases, which is considered as one of the most important reasons for failure in therapies and death of patients during clinical treatment. Age, clinical stages as well as genders of NSCLC patients are used to be reported as relevant factors of CNS metastases. However, a biological marker which is significantly related to NSCLC CNS metastases is still yet to be found. Albeit lots of tumor markers are recruited to the diagnosis and treatment for NSCLC currently, their site-specific metastatic prognostic potential is still not well understood.257clinical pathological characteristics, the amount of serum tumor markers on diagnosis were retrospectively analyzed. Also, the correlation between serum tumor markers and brain metastases was analyzed.82patients, who have been diagnosed with brain metastases, were further analyzed in order to identify the relationship between the dynamic changes of serum tumor markers and the prognosis of brain metastases as well as the efficacy of corresponding therapies, which, correspondingly, could be important in early prediction, evaluation of therapeutic efficacy and prognosis of brain metastases patients.MethodClinical data of257eligible patients, who were diagnosed with NSCLC and had been treated at Henan Cancer Hospital between January2006and May2011, was retrospectively analyzed. All patients in this study were, for the first time, diagnosed with advanced non-small cell lung cancer. Level of serum tumor markers and clinical pathological features of patients were recorded before initial treatment. For those who were diagnosed with brain metastases, the onset and development of metastasis were collected. Also, serum tumor marker levels of those patients were measured before and after treatment respectively. Short-term efficacy was evaluated via imageological methods and the relationship between the dynamic changes of serum tumor markers was analyzed. Also, serum tumor markers and clinical data were further analyzed to identify the revelant factors associated with protnosis of patients with brain metastasis.Results1. Within188patients that developed adenocarcinoma,71cases (37.8%) were complicated by brain metastases. However, for those who were diagnosed with squamous cell carcinoma as well as other types of NSCLC,11cases (15.9%) had brain metastatic lesions.168cases (65.4%) have high serum carcinoembryonic antigen (CEA) level, and39.3%of them with brain metastases.89cases (34.6%) have normal serum CEA level, and of them16.9%with brain metastases.Serum CEA level of patients with brain metastases was significantly higher than that of patients without brain metastases.(P<0.0001)2. Serum CEA was evaluated according to different cut-off value via receiver operating characteristic (ROC) curve. And CEA level higher htan lOug/ml was found to be considered as an appropriate cut-off value for risk prediction of brain metastasis, which has sensitivity of70.7%, specificity of66.9%and area under ROC curve of0.68(P<0.0001;95%CI:0.59～0.75), when used as a predictor for brain metastasis. 3. For those82patients with brain metastases,46cases responded to treatment (CR+PR), and13patients had progressed disease, and23patients developed stable disease. Those who responded to treatment had decreased serum CEA (P=0.013), and the serum CEA increased in those who had progressed diease (P=0.029), while the CEA level were not significantly changed in patients with stable disease (P=0.058). neuron specific enolase (NSE) and cytokeratin fragment21-1(CYFRA21-1) which are also tumor markers did not show any significant difference.4. Results from univariate analysis indicated that, treatment regime, age (≥65year old), male, poor performance status (PS score>1), high serum CEA level (≥5ug/ml) and the number of brain metastatic lesion (≥2) are relevant factors for poor prognosis. And multivariate analysis showed that, performance status (PS score), serum CEA level and treatment regime could be independent prognostic factors.Conclusion1. Serum CEA level before initial treatment was correlated with brain metastasis in advanced NSCLC patients. Examination of serum CEA level is significant in treatment efficacy evaluation and prognosis prediction in patients with brain metastasis.2. PS score, treatment regime and serum CEA level could be the independent prognostic factors for patients with NSCLC brain metastasis. |
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