| Primary lung cancer is the most common and fatal malignancy around the world.85% cases of lung cancer is non-small cell lung cancer(NSCLC),and the prognosis of this patients is usually not optimistic.The precise prediction of the patient's long-term survival risks is be beneficial to the treatment selection and follow-up process.Carcino-embryonic antigen(CEA)is the most frequently used tumor marker for NSCLC patients,which is widely applicated for auxiliary diagnosis and curative effect monitoring.Previous studies reported that serum CEA level has a certain prognostic value for NSCLC patients,however,there is not enough studies with large-sample and well-controlled confounding factors.Objective: The current study aimed to employing appropriate statistical methodology and large-sample cohorts,to explore the prognostic of the preoperative serum CEA level for NSCLC patients.Methods: The current study is a retrospective cohort-study,which consecutively included 1130 NSCLC patients treated by thoracic surgery.The patients was derivedinto two groups by preoperative CEA levels.The confounding variables were compromised by propensity score matching(PSM).Survival curves were drawn by Kaplan-Miere survival analysis.Univariate and multivariate analysis were conducted via Cox proportional hazard regression model.The comparison between the current study and the combined effect of previously published studies were analyzed by cumulative meta-analysis.Results: The median overall survival time of the total 1130 NSCLC patients was44(0-61)months,and the overall 5-year survival rate was 47.1%.The median disease-free survival time was 35(0-61)months,and the 5-year disease-free survival rate was 46.3%.There was statistical difference in overall survival and disease-free survival time between the two groups.After PSM,the confounding variables were well-controlled,and the survival differences between two groups still existed.The Cox univariate analysis showed that the overall and disease-free survival hazard ratio(HR)of the high-CEA level patients was 1.595(95%CI 1.329-1.863,p=0.004)and 1.498(95%CI 1.271-1.881,p=0.004).The multivariate analysis that the overall and disease-free survival hazard ratio(HR)of the high-CEA level patients was 1.586(95%CI 1.398-1.812,p=0.016)and 1.413(95%CI 1.22-1.734,p=0.022).Meta-analysis showed that the cumulative effect was similar with the combined effect of the previously published studies.Conclusions:(1)The preoperative serum CEA level was an independent influence factor for overall /disease-free survival time of NSCLC patients.(2)The preoperative serum CEA level has predictive value among NSCLC patients with the same p TNM stages or pathological stages.(3)The predictive value of preoperative serum CEA levelin the current study was similar with that of the combination of the previously published studies. |
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