摘要
目的小细胞肺癌(small-cell lung cancer,SCLC)是一种生长迅速并且具有神经内分泌特异的肿瘤。约2/3的SCLC癌细胞可以产生胃泌素释放肽前体(pro-gastrin-releasing peptide,ProGRP),ProGRP被认为是SCLC的理想标志物。因此,本研究探讨SCLC患者ProGRP与神经元特异性烯醇化酶(neuron specific enolase,NSE)变化对评估化疗疗效及预后的价值。方法收集2012-04-06-2013-12-31山东省肿瘤医院122例初治SCLC患者,第1和3次化疗前抽取外周静脉血,分别采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)和电化学发光法(eletro-chemiluminescence immunoassay,ECLIA)检测患者血清ProGRP和NSE的浓度,并按RECIST 1.1评价标准判断疗效,分析化疗前后肿瘤标志物的变化与近期疗效、无进展生存期(progression free survival,PFS)的关系。结果 122例患者经2个周期化疗后,完全缓解(complete response,CR)4例,部分缓解(partial response,PR)80例,稳定(stable disease,SD)26例,进展(progressive disease,PD)12例。有效(CR+PR)组、SD组的ProGRP和NSE浓度均较治疗前明显下降,P值均<0.05。PD组ProGRP浓度高于化疗前,P<0.05;而NSE浓度化疗前后差异无统计学意义,P>0.05。ProGRP高(>43ng/L)和低水平组(≤43ng/L)中位PFS分别为7.0和9.9个月,P<0.05;NSE高水平组(>17ng/mL)中位PFS为6.9个月,低于低水平组(≤17ng/mL)的9.9个月,P<0.05。Cox回归分析结果显示,NSE是有意义的预后因素,HR=3.77,P<0.05;而ProGRP对预后无影响,P>0.05。结论在监测化疗疗效方面ProGRP优于NSE,而在预后评估方面NSE更有优势,二者可以互为补充,在临床工作中发挥更大作用。
OBJECTIVE Small cell lung cancer （SCLC） is a repidly growing neoplasm, which has a neuroendocrine cellular origin. ProGRP is produced in about two-thirds of SCLC tumor cells and is recognized as an ideal tumor marker for SCLC. To investigate the clinical value of ProGRP and NSE for therapy monitoring and predicting survival in patients with SCLC. METHODS The serum levels of ProGRP and NSE were detected by enzyme-linked immunosorbent assay （ELISA） and eletro-chemiluminescence immunoassay （ECLIA） in 122 SCLC patients without prior therapy. Blood samples were obtained before the first and the third chemotherapy. The RECIST criteria were adopted to assess the therapeu tic efficacy. The relationship between changes of tumor markers,therapeutic efficacy and progression free survival（PFS） was analyzed. RESULTS After 2 courses of chemotherapy, the number of complete response （CR）, partial response （PR）,stable disease （SD） and progressive disease （PD） were 4,80,26 and 12 according to RECIST criteria. The concentrations of ProGRP and NSE in CR＋PR group and SD group had decreased significantly in comparison with pretreatment concentrations,the difference was statistically significant （all the P〈0.05）. Significant increase in the ProGRP concentration of PD group was seen after and before chemotherapy （P〈0.05）,while NSE was not （P〈0.05）. According to univariate analysis of Kaplan-Meier, the median PFS of high ProGRP group （≥43 ng/L） and low ProGRP group （≤43 ng/L） were 7.0 and 9.9 months,respectively,the difference was significant （P〈0.05）. The median PFS of high NSE group （〉 17 ng/mL） was 6. 9 months, which was statistically shorter than 9. 9 months of low NSE group （≤17 ng/mL） （P〈0.05）. The multivariate COX regression analysis found the hazard ratio （HR） of NSE was 3.77, suggesting that it was a significant prognostic factor （P〈0. 05）. However, ProGRP was not prognostic （P〉0.05）. CONCLUSION ProGRP is superior to NSE in monitoring the therapeutic effect of chemotherapy,and NSE is better to evaluate the prognosis, they can supplement with each other＇s advantages to play greater roles in clinical work.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2015年第22期1774-1778,共5页
Chinese Journal of Cancer Prevention and Treatment
