Cyfra 21-1, neuron specific enolase and prognosis of non-small cell lung cancer: prospective study in 621 patients
Cyfra 21-1, neuron specific enolase and prognosis of non-small cell lung cancer: prospective study in 621 patients
复制标题
DOI：
10.1016/s0169-5002(00)00186-0
复制
发表时间：
2001-02-01
期刊：
影响因子：
5.3
通讯作者：
Quantin, X
中科院分区：
文献类型：
--
作者：
Pujol, JL;Boher, JM;Quantin, X
背景：血清细胞角蛋白19片段CYFRA 21-1和烯醇化酶γ亚基神经元特异性烯醇化酶（NSE）被认为是肺癌的标志物。它们作为非小细胞肺癌（NSCLC）预后因素的临床适用性需要在长期随访的大量人群中同时评估其他已知的生存决定因素。目的：探讨不同临床及常规生物学指标对预后的影响，特别关注上述指标；方法对621例经组织学证实且未接受治疗的非小细胞肺癌患者进行前瞻性研究（其中7例未随访）。中位随访时间为4年零2个月。在报告时，记录了16个临床和生物学变量。血清NSE和CYFRA 21-1在没有任何临床资料的情况下进行盲法测定。结果：血清CYFRA 21-1的分布在不同的组织学、疾病分期和性能状态有显著差异，在鳞状细胞癌、转移期最高。纵隔淋巴结阳性，表现不佳。然而，各自的“接受者工作特征”曲线显示CYFRA 21-1血清水平不能准确预测肿瘤分期。血清NSE分布与肿瘤分期和表现指数均无相关性，在整个NSCLC中的敏感性较低。在Cos比例风险模型中，以下变量是不良结果的独立决定因素：表现状态2或3。风险比（HR）： 2.25，淋巴结状态N-2 (3), HR: 1.84；转移性疾病，HR: 1.73；NSE > 12.5 ng:ml。HR: 1.52; CYFRA 21-1 > 3.6 ng/ml, HR: 1.41；肿瘤状态t - 34， HR: 1.31。当生存分析仅限于274例受转移期影响的患者时，我们观察到功能状态、淋巴结状态、NSE和CYFRA 21-1仍然是预后决定因素，风险比相似。结论：高血清CYFRA 21-1水平提供的预后信息独立于其他众所周知的变量，如工作状态和疾病分期，并在延长的随访期间具有长期性。高的NSE水平也可能反映了肿瘤的异质性和低估的神经内分泌分化，从而预示了不良的预后。(C) 2001爱思唯尔科学爱尔兰有限公司版权所有。
Background: CYFRA 21-1, a serum cytokeratin 19 fragment, and neuron specific enolase (NSE), the gamma -subunit of enolase, are putative markers of lung cancer. Their clinical applicability as prognostic factors in non-small cell lung cancer (NSCLC) would need an appraisal by simultaneous evaluation of other known survival determinants in a large population followed over a long period. Aim: To determine the prognostic value of different clinical and routine biological variables at presentation with particular attention paid to the above-mentioned markers.;Methods 621 histologically proven and previously untreated NSCLC patients have been prospectively studied (seven were lost to follow-up). Median follow-up was 4 years and 2 months. At presentation, 16 clinical and biological variables were recorded. Serum NSE and CYFRA 21-1 were assayed blind without any clinical information given. Results: The serum CYFRA 21-1 distribution differed significantly according to histology, disease stage and performance status, with the highest levels observed in squamous cell carcinomas, metastatic stage. positive mediastinal nodal status and poor performance status. However, the respective 'receiver operating characteristic' curves showed that the CYFRA 21-1 serum level did not accurately predict tumour stage. Serum NSE distribution correlated neither with tumour stage nor with performance index and its sensitivity in the whole NSCLC was low. In the Cos proportional hazard model, the following variables were independent determinants of a poor outcome: performance status 2 or 3. hazard ratio (HR): 2.25, Nodal status N-2 (3), HR: 1.84: Metastatic disease, HR: 1.73; NSE > 12.5 ng:ml. HR: 1.52: CYFRA 21-1 > 3.6 ng/ml, HR: 1.41 and Tumour status T-3 4, HR: 1.31. When the survival analysis was restricted to the 274 patients affected by a metastatic stage, we observed that performance status, nodal status, NSE and CYFRA 21-1 remained prognostic determinants with similar hazard ratios. Conclusion: The prognostic information given by a high serum CYFRA 21-1 level is independent from other well-known variables such as performance status and disease stage and is perennial throughout extended follow-up period. A high NSE level also prognosticates a poor outcome probably by reflecting tumour heterogeneity and underestimated neuroendocrine differentiation. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.