The Value Of CYFRA21-1 And CEA Change Rates In Evaluating The Efficacy And Prognosis Of Osimertinib Targeted Therapy In Advanced Non-small Cell Lung Cancer

Background and purpose: At present,the efficacy evaluation of osimertinib targeted therapy for lung cancer usually adopts RECIST 1.1 evaluation criteria,but it still has certain shortcomings.In this study,we investigated the value of CYFRA21-1change rate and CEA change rate in evaluating the efficacy and prognosis of osimertinib targeted therapy in patients with advanced non-small cell lung cancer and EGFR-sensitive mutations,in order to provide a valid,convenient and economic evaluation index for the efficacy evaluation and prognosis assessment of osimertinib targeted therapy.Materials And Methods: This study included clinical data of patients with advanced non-small cell lung cancer admitted to Zhejiang Provincial People’s Hospital with EGFR-sensitive mutations and first-line and post-line targeted treatment with osimertinib from January 1,2019 to October 1,2022.The levels of CYFRA21-1 and CEA as well as age,gender,weight loss,smoking index,ECOG PS score,EGFR gene mutation type,pathological staging,gross staging status and progression-free survival were collected before and after 4 weeks of treatment with osimertinib.The spss version 26.0 statistical software was used to compare using the chi-square test or Fisher’s exact test,and further logistic multi-factor regression was performed to analyze the value of their evaluation of efficacy and to draw ROC curves.The Kaplan-meier method and COX multifactor regression were used to analyze the prognostic factors of patients,and P<0.05 was considered statistically significant.Results: 1.Patients with elevated CYFRA21-1 levels were included,79 in first-line and 91 in post-line.The area under the ROC curve for DC evaluation of the efficacy of first-line and post-line osimertinib treatment was 0.973(P<0.001)and 0.915(P<0.001),respectively,with thresholds of 10.5% and 11.5%,respectively,and sensitivities and specificities were all >80%.KM survival analysis showed that m PFS was significantly shorter in both CYFRA21-1 change rate 1 and CYFRA21-1 change rate 2 positive patients than in negative patients(5.0 months vs.16.0 months,P<0.05;7.4 months vs.14.0 months,P<0.05).COX multifactorial risk regression analysis showed that CYFRA21-1 change rates 1 and 2 were both independent prognositic factors influencers in predicting PFS in patients with advanced lung cancer(both P values <0.05).2.Patients with elevated CEA levels were included,87 in first-line and 92 in post-line.the area under the ROC curve for CEA level change rate to evaluate the efficacy of DC with first-line and post-line osimertinib treatment was 0.956(P<0.001)and 0.981(P<0.001),respectively,with thresholds of 12.5% and 14.5%,respectively,and sensitivities and specificities were all >80%.The KM survival analysis showed that m PFS was significantly shorter in both CEA change rate 1 and CEA change rate 2positive patients than in negative patients(5.5 months vs.17.0 months,P<0.05;8.0months vs.13.0 months,P<0.05).COX multifactorial risk regression analysis showed that both CEA change rate 1 and 2 were independent prognositic factors influencers in predicting PFS in patients with advanced lung cancer(both P values < 0.05).3.There was no difference in the efficacy of CYFRA21-1 change rate and CEA change rate in evaluating imaging efficacy DC in first-line osimertinib targeted therapy(P>0.05),and there was no difference in the efficacy of both in evaluating imaging efficacy DC in post-line(P>0.05);there was no difference in the efficacy of CYFRA21-1 change rate in evaluating efficacy of osimertinib first-line and post-line targeted therapy(P>0.05).There was also no difference in the efficacy of CEA change rate to evaluate the efficacy of first-line and post-line targeted therapy(P>0.05).Conclusions: 1.In EGFR-sensitive mutant advanced NSCLC with elevated CYFRA21-1,CYFRA21-1 change rates can effectively evaluate the efficacy of first-line and post-line targeted therapy with osimertinib,and can effectively assess the m PFS of patients;2.In advanced NSCLC with EGFR-sensitive mutations with elevated CEA,CEA change rates can effectively evaluate the efficacy of first-line and post-line targeted therapy with osimertinib,and can effectively assess the m PFS of patients;3.There was no significant difference in the efficacy of efficacy evaluation between CYFRA21-1 change rate and CEA change rate,and there was no difference in the efficacy of the both respectively in evaluating the efficacy of first-line and post-line targeted therapies.