Usefulness of the serum carcinoembryonic antigen kinetic for chemotherapy monitoring in patients with unresectable metastasis of colorectal cancer
Usefulness of the serum carcinoembryonic antigen kinetic for chemotherapy monitoring in patients with unresectable metastasis of colorectal cancer
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DOI：
10.1200/jco.2007.15.0904
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发表时间：
2008-08-01
影响因子：
45.3
通讯作者：
Michel, Pierre
中科院分区：
文献类型：
--
作者：
Iwanicki-Caron, Isabelle;Di Fiore, Frederic;Michel, Pierre
目的探讨结直肠癌不可切除转移患者血清癌胚抗原（CEA）动力学与化疗反应的关系。患者和方法采用连接CEA半对数值的指数回归曲线斜率计算动力学。绘制受试者工作特征（ROC）曲线，选择CEA斜率阈值，以最高的敏感性、特异性和诊断准确性比值比（DOR）来定义进行性或反应性疾病的患者。采用Cox模型和Kaplan-Meier方法评估CEA斜率与无进展生存期（PFS）的相关性。结果共纳入122例患者。以CEA斜率大于+ 0.05定义病程进展，敏感性为85.7%，特异性为85.1%，DOR为34。ROC曲线下面积为0.885 （95% CI, 0.815 ~ 0.936; P = 0.0001）。CEA斜率小于-0.2定义的反应敏感性为74.7%，特异性为82.5%，DOR为16。AUROC曲线为0.847 （95% CI, 0.770 ~ 0.906; P = 0.0001）。用6个CEA值和4个CEA值计算的AUROC曲线差异不显著。PFS与CEA斜率相关（风险比，4.6;95% CI, 2.48 ~ 8.57）。CEA斜率值小于-0.2个月的患者中位PFS为10个月，而CEA斜率值大于-0.2的患者中位PFS为6个月（P < 0.0001）。结论CEA动力学是一种准确、简便、无创的判断结直肠癌不可切除转移患者病情进展的方法。
Purpose The aim of the study was to evaluate the relationship between serum carcinoembryonic antigen (CEA) kinetic and response to chemotherapy in patients with unresectable metastasis of colorectal cancer.Patients and Methods The kinetic was calculated using the slope of an exponential-regressive curve connecting the semi-logarithmic values of CEA. Receiver operating characteristic (ROC) curves were drawn to select the CEA slope thresholds to define patients with progressive or responsive disease with the highest sensitivity, specificity, and diagnosis accuracy odds ratio (DOR). The correlation between the CEA slopes and progression-free survival (PFS) was evaluated by the Cox model and Kaplan-Meier methods.Results A total of 122 patients were included. Progression defined by CEA slope greater than + 0.05 resulted in sensitivity of 85.7%, specificity of 85.1%, and DOR of 34. The area under the ROC (AUROC) curve was 0.885 (95% CI, 0.815 to 0.936; P = .0001). Response defined by CEA slope less than -0.2 resulted in sensitivity of 74.7%, specificity of 82.5%, and DOR of 16. The AUROC curve was 0.847 (95% CI, 0.770 to 0.906; P = .0001). The difference between AUROC curves calculated with six or four CEA values was not significant. PFS was correlated with CEA slopes (hazard ratio, 4.6; 95% CI, 2.48 to 8.57). The median PFS was 10 months for patients with CEA slope values less than -0.2 months versus 6 months for patients with CEA slope values greater than -0.2 (P < .0001).Conclusion These results suggest that the CEA kinetic is an accurate, simple, and noninvasive method to identify the disease progression in patients with unresectable metastasis of colorectal cancer.