Significance Of CEA And CYFRA21-1 With Efficacy And Prognosis Of EGFR-TKI Treatment In Lung Adenocarcinoma

Objective:The efficacy of EGFR-TKI in the treatment of EGFR gene mutations in patients with advanced NSCLC is controversial.Because of the difference between the mechanism of EGFR-TKI and traditional chemotherapeutic drugs,the simple RECIST evaluation method is lack of scientific and requires new evaluation criteria and methods,but limited to some of the functional diagnosis of expensive,if commonly used economic assessment of the means of joint application can play a good assessment effect.This study was to investigate the significance of CEA and CYFRA21-1 change rate with efficacy and prognosis of EGFR-TKI treatment in lung adenocarcinoma,and analyze the difference between CEA and CYFRA21-1 change rate in efficacy judgment,to provide a cost-effective means for evaluating the efficacy and prognosis of EGFR-TKI targeted therapy.Methods:1、We collected 90 lung adenocarcinoma(which confirmed by histopathology)patients with treatment by EGFR-TKI in XX Hospital from January 2011 to January 2015,accompanied by EGFR19 exon mutation in 55 cases,21 exon mutation in 35 cases.Of these patients,cases of the male were 27(30%)and the female were 63(70%),the median age was 61.7 years old(37 years old to 79 years old).We collected the basic clinical information of patients,included age,smoking status,TNM stage,pathologic type,other metastatic site,treatment status,effect evaluation,progression-free survival and so on.All patients had complete test results before and after 4 weeks of serum CEA and CYFRA21-1,and imaging results.2、The statistical analysis of the data was performed by SPSS20.0.We used the ROC curve to determine the optimal cut-off point of CEA and CYFRA21-1 change rate in recent efficacy.The Mann-Whitney test was used to analyze the correlation between the efficacy of EGFR-TKI and CEA、CYFRA21-1 change rate.Kaplan-Meier method analyzed the PFS and depicted the survival curve at the same time.The chi-square test was used to analyze the difference between CEA and CYFRA21-1 change rate in efficacy judgment.All tests in this paper are bilateral inspection.With P<0.05 was considered statistically significant.Results:1、We selected 76 cases which baseline level of CEA were elevated and baseline level of CYFRA21-1 were not restricted.ROC curve area of the CEA change rate with RECIST criteria for evaluation of efficacy is 0.643(95%CI 为 0.519-0.767),while the best cut-off point of CEA is decreased to 22.88%,then sensitivity were 0.719 and specificity were 0.535.(P=0.035)Analyze the correlation of CEA change rate and the evaluation in the cut-off point.The effective rate of CEA change rate>22.88%was 52.3%,and CEA change rate≤22.88%was 28.1%,P=0.023,it proved that the efficacy of EGFR-TKI treatment is better when the CEA change rate>22.88%.Reduce the magnitude of the ROC curve based on the best cut-off point corresponding to the CEA,76 patients were divided into CEA reduced>22.88%of the group and the CEA group<22.88%drop.Comparing two groups of PFS,CEA reduced>22.88%group median PFS was 9.5 months,CEA reduced<22.88%median PFS was 7.0 months.(P=0.035)2、We selected 69 cases which baseline level of CYFRA21-1 were elevated and baseline level of CEA were not restricted.ROC curve area of the CYFRA21-1 change rate with RECIST criteria for evaluation of efficacy is 0.677(95%CI 为 0.554-0.779),while the best cut-off point of CYFRA21-1 is decreased to 28.64%,then sensitivity were 0.788 and specificity were 0.595.(P=0.009)Analyze the correlation of CYFRA21-1 change rate and the evaluation in the cut-off point.The effective rate of CYFRA21-1 change rate>28.64%was 51.3%,and CEA change rate<28.64%was 23.3%,P=0.026,it proved that the efficacy of EGFR-TKI treatment is better when the CYFRA21-1 change rate>28.64%.Reduce the magnitude of the ROC curve based on the best cut-off point corresponding to the CYFRA21-1,69 patients were divided into CYFRA21-1 reduced>28.64%of the group and the CYFRA21-1 group≤28.64%drop.Comparing two groups of PFS,CYFRA21-1 reduced>28.64%group median PFS was 9.0 months,CYFRA21-1 reduced≤28.64%median PFS was 7.0 months(P=0.009)3.We selected 55 cases which baseline level of CEA and CYFRA21-1 were both elevated,filtered 29 cases that CEA and CYFRA21-1 change rate were both higher than the best cut-off point.According to the cut-off point,we used CEA>22.88%and CYFRA21-1>28.64%as evaluation methods separately to analyze the difference between CEA and CYFRA21-1 change rate in efficacy.P>0.05,we think that there was no significant difference between the CEA and CYFRA21-1 change rate in efficacy judgment.Conclusions:CEA and CYFRA21-1 change rate can be used as a prognostic indicator of efficacy and prognosis with treatment EGFR-TKI in lung adenocarcinoma.