| Background Recently, gefitinib and erlotinib have been successfully used in clinical therapy for non-small cell lung cancer(NSCLC) as the representative of the epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs), and become one of the best specific anti-tumor therapies because of their remarkable efficacy and minimal side effects. Choice of targeted drug depends on the detection and confirmation of molecular targets in tumors. It has been confirmed that clinical sensitivity of NSCLC patients applying with molecular targeted therapy such as TKIs, is related closely to EGFR gene mutations. And so, it was necessary to detection for the EGFR mutations before targeted therapy of EGFR-TKIs. To some extent, it promoted cancer therapeutics from the traditional "treatment response mode" to "individual forecasting model". Gene sequence analysis is a classical technique for EGFR gene mutations detection, and has been widespread recognized by clinical ace demists. More and more molecular diagnostic techniques had emerged currently, with increased sensitivity and specificity for gene mutations. However, most of them require tumor specimens from surgical resection or biopsy, even the amount of tumor cells. Much to regret, most of lung cancer patients lost the chance of operation in diagnosis duration, even difficultly to obtain tissue specimens by needle biopsy. In addition, tomor tissue specimens have great limitations of reflecting EGFR mutations because of the dynamic of tumor cell activities, especially after the impact of radiotherapy and chemotherapy.Serum carcinoembryonic antigen(CEA) levels are a predictor of epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI) efficacy and are associated with epidermal growth factor receptor(EGFR) gene mutations. However, the clinical significance of plasma CEA level changes during different cycles of target therapy is unknown for lung adenocarcinoma patients with sensitizing EGFR mutations.Purpose Evaluate serum carcinoembryonic antigen(CEA)prognosis and predictive value in the epidermal growth factor(EGFR) gene has been mutated in lung adenocarcinoma patients.Methods In total, 155 patients with lung adenocarcinoma were enrolled in this retrospective study between 2011 and 2015. EGFR mutations were detected by RT-PCR(real-time quantitative PCR). Plasma CEA levels were measured prior to different EGFR-TKI treatment cycles. Computed tomography(CT) scans were conducted every 2 months to assess the therapeutic efficacy.Results Serum CEA concentrations were significantly associated with EGFR mutations(p<0.05). Furthermore, in all patients treated with EGFR-TKIs, the serum CEA levels increased with disease progression(p<0.005). Serum CEA levels <5ng / ml in patients with efficiency(PR + CR) was 18.9%(5/24), disease control rate(PR + CR + SD) was 38.7%(9/24); Patients with serum CEA levels ? 5ng / ml of the effective rate of 31.6%(14/45), disease control rate was 80.2%(36/45). The efficacy of the two groups of patients treated by EGFR-TKIs have statistically different(P<0.05=.After taking the EGFR-TKIs, the patients with high levers of serum CEA suffered from a good effect than the patients with low levers of serum CEA. Further analysis of the clinical features of the two groups were generally found no statistically significant difference(P> 0.05). A COX multivariate analysis revealed that CEA levels 16.2 times above normal were associated with early disease progression(HR, 5.77; 95%CI:2.36~14.11; p<0.001). Based on this finding, a threshold was set at the median time of 8.3 months. Patients with EGFR mutations exhibited a median progression-free survival time of 12.8 months. Serum CEA levels were markedly increased compared to levels measured 4.5 months prior to the changes detected via CT scans for patients resistant to EGFR-TKIs.Conclusion High levels of serum CEA may be the EGFR-TKIs treatment of lung adenocarcinoma prognosis and predictive factors. |
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