Identifying patients at risk of early postoperative recurrence of lung cancer: A new use of the old CEA test
Identifying patients at risk of early postoperative recurrence of lung cancer: A new use of the old CEA test
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DOI：
10.1016/s0003-4975(02)04638-6
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发表时间：
2003-03-01
影响因子：
4.6
通讯作者：
Ferrigno, D
中科院分区：
文献类型：
--
作者：
Buccheri, G;Ferrigno, D
背景在本研究中，我们报告了癌胚抗原（CEA）预测非小细胞肺癌（NSCLC）肺切除术后早期肿瘤复发的能力。我们研究了118例连续的非小细胞肺癌患者，这些患者在临床上被判断为可手术，并最终接受了手术。记录人体测量、临床和CEA数据以及术前和术后分期结果沿着。所有患者术后随访至少1年，记录首次临床复发的时间。采用受试者工作特征曲线和诊断公式进行数据分析。结果在该系列中，CEA检测是预测早期术后复发最准确的方法之一（ROC面积：0.72，95%置信区间[CI]：0.60至0.85，p = 0.001; CEA在10 ng/mL阈值时的准确率：83%，CI：76%至90%）。术后病理分期也具有预测性（ROC面积：0.68，CI：0.56 - 0.80，p = 0.007）。在病理分类为Ia至IIb期的肿瘤中，术前CEA水平高于10 ng/mL与67%的肿瘤复发概率相关。在相同的疾病阶段，CEA水平低于10 ng/mL的基线无复发概率从80%增加到88%。在可手术的NSCLC患者中，CEA血清浓度异常的频率较低（在我们的系列中为17%）。然而，重要的是要确定这样一小群高风险患者，因为其中许多患者（在我们的研究中，CEA值分别超过5和10 ng/mL的患者中有55%和70%）将发生早期术后复发。这类病人即使没有可疑的症状和体征，也应该在术前通过纵隔镜或正电子发射断层扫描进行检查。然后在一个明显成功的手术后，他们应该仔细跟进。这些患者可能是选定高危人群新辅助治疗临床试验的合适靶点。
Background. In the current study, we report the carcinoembryonic antigen (CEA) capability to predict early tumor relapses after a pulmonary resection for nonsmall cell lung cancer (NSCLC).Methods. We studied 118 consecutive NSCLC patients who were clinically judged operable and were eventually operated upon. Anthropometric, clinical, and CEA data along with the results of both preoperative and postoperative stage classifications were recorded. All patients were followed up for at least 1 year after surgery and the time to the first clinical recurrence recorded. Receiver-operating characteristic (ROC) curves and diagnostic formulas were used for data analysis. Results. In this series the CEA test was among the most accurate methods to predict an early postoperative recurrence (ROC area: 0.72, 95% confidence interval [CI]: 0.60 to 0.85, p = 0.001; accuracy rate for CEA at the threshold of 10 ng/mL: 83%, Cl: 76% to 90%). Also predictive was the postoperative pathologic stage of disease (ROC area: 0.68, Cl: 0.56 to 0.80, p = 0.007). In tumors pathologically classified in stage Ia to IIb, a preoperative CEA level higher than 10 ng/mL was associated with a 67% probability of tumor relapse. In the same stages of disease, a CEA level less than 10 ng/mL increased the baseline probability of no recurrence from 80% to 88%.Conclusions. In operable patients with NSCLC the frequency of abnormal serum concentrations of CEA is low (17% in our series). However, it is important to identify such a small group of high-risk patients as many of them (in our study, 55% and 70% of those with a CEA value in excess of, respectively, 5 and 10 ng/mL) will develop an early postoperative recurrence. Such patients should be investigated preoperatively by mediastinoscopy or positron emission tomography in even in the absence of suspicious symptoms and signs. Then after an apparently successful operation, they should be carefully followed up. These patients could represent a suitable target for neoadjuvant clinical trials of selected high-risk groups.