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目的探讨表皮生长因子受体(EGFR)基因与血清癌胚抗原(CEA)水平对晚期非小细胞肺癌(NSCLC)患者一线口服吉非替尼治疗效果的预测价值。方法回顾性分析76例一线口服吉非替尼的晚期NSCLC患者的临床资料,实时荧光定量PCR法(ARMS法)检测患者肿瘤组织中EGFR基因突变情况,电化学发光免疫法测定患者血清CEA水平,电话或门诊随访患者生存情况,分析上述患者EGFR基因突变情况及血清CEA水平与其口服吉非替尼治疗效果的关系。结果晚期NSCLC患者的EGFR突变阳性率与性别、病理类型及血清CEA水平具有相关性,即女性、腺癌、血清CEA≥5ng/ml的患者突变率高(χ2值分别为4.413、4.956、4.070,P值分别为0.36、0.026、0.044)。进一步分析显示随着血清CEA水平的增高EGFR突变率随之增高(χ2=6.246,P=0.040)。Cox回归模型多因素分析EGFR突变情况、吸烟史及血清CEA水平与一线口服吉非替尼的晚期NSCLC患者的远期疗效具有相关性(RR=2.631、0.421、1.850,P=0.002、0.028、0.004),且EGFR突变阳性、无吸烟史、血清CEA≥5ng/ml的患者疾病进展时间明显延长(P<0.05)。结论血清CEA水平不仅是NSCLC患者EGFR突变状态的预测指标之一,而且可以作为预测晚期NSCLC患者服用吉非替尼的疗效指标。
Objective To investigate the predictive value of epidermal growth factor receptor (EGFR) gene and serum carcinoembryonic antigen (CEA) in the first-line oral treatment of gefitinib in patients with advanced non-small cell lung cancer (NSCLC). Methods The clinical data of 76 NSCLC patients with first-line gefitinib were analyzed retrospectively. The mutation of EGFR gene in tumor tissue was detected by real-time fluorescence quantitative PCR (ARMS). The level of CEA in serum was detected by electrochemiluminescence immunoassay, Telephone or outpatient follow-up of patients with the survival of patients with EGFR gene mutations and serum CEA levels and its relationship with the efficacy of gefitinib oral administration. Results The positive rate of EGFR mutation in patients with advanced NSCLC was correlated with sex, pathological type and serum CEA level. The mutation rates of female, adenocarcinoma and serum CEA≥5ng / ml were high (χ2 = 4.413,4.956,4.070, P values were 0.36,0.026,0.044 respectively). Further analysis showed that EGFR mutation rate increased with the increase of serum CEA level (χ2 = 6.246, P = 0.040). Cox regression model multivariate analysis of EGFR mutations, smoking history and serum CEA levels and first-line gefitinib advanced NSCLC patients with long-term efficacy (RR = 2.631,0.421,1.850, P = 0.002,0.028,0.004 ), And EGFR mutation positive, no smoking history, serum CEA ≥ 5ng / ml patients with disease progression significantly longer (P <0.05). Conclusion Serum CEA level is not only one of the predictors of EGFR mutation in NSCLC patients, but also can be used as a predictor of gefitinib in patients with advanced NSCLC.