Correlation Of CEA,CA125 And CYFRA21-1 With The Clinical Characteristics And Prognosis In Advanced Non-small Cell Lung Cancer

Objective:To investigate the relationships between the serum level of carcinoembryonic antigen(CEA), Carbohydrate antigen 125(CA125) and Cytokeratin 19 fragment (CYFRA21-1) and the clinical characteristics and prognosis in non-small cell lung cancer by retrospective study, and explore the value in the diagnosis and treatment for lung cancer.Materials and Methods:We Collected 302 patients in the First Affiliated hospital of Dalian Medical University hospital from January 2008 to January 2013 who were diagnosed as non-small cell lung cancer by organizing cytology or pathology, all of patients have complete clinical data. There have 158 patients left through a strict inclusion criteria and exclusion criteria. Patients in 100 cases (63.3%) are men and 58 cases (36.7%) are women, The oldest is 89 years old,the youngest is 36 years old age, the median age is 63 years old. There have 104 cases (65.8%)for pathological types of adenocarcinoma and squamous cell carcinomas patients for 43 cases (27.2%),2 cases are large cell lung cancer (1.3%), other types (poorly differentiated non-small cell carcinoma) are 9 cases (5.7%). All patients have test the level of serum CEA, CA125, CYFRA21-1 when they were diagnosis with lung cancer or before the first teartment. We collected the information and analyzed the correlation with the level of CEA, CA125, CYFRA21-1.Statistical analysis:We used SPSS 19.0 software for statistical data analysis, The normal distribution of the data are analyzed by Chi-Square test. Using Wilcoxon rank sum test to analysis the correlation between the level of tumor markers and treatment effect; Survival curve was draw by survival analysis of Kaplan-Meier method, using Log-rank to testthe differences between the levels of tumor markers in normal group and higher survival rate. The differences have statisticall significant when P<0.05.Result:1. No differences in CEA, CA125, CYFRA21-1 levels were detected according to gender, age (P> 0.05).2. Compare two groups with different types of tissue, we found that in 104 patients who’s tissue types was adenocarcinoma there were 72 cases with CEA positive, the positive rate was 69.2%, CA125 positive was in 75 patients, the positive rate was 72.1%, CYFRA21-1 positive was in 68 patients, the positive rate was 65.4%. The positive of CEA and CA125 in adenocarcinoma group were significantly higher than the patients with lung squamous carcinoma group(P<0.05). In 43 patients who’s tissue types was adenocarcinoma there were 17 cases with CEA positive, the positive rate was 39.5%, CA125 positive was in 21 patients, the positive rate was48.8%, CYFRA21-1 positive was in 35 patients, the positive rate was 81.4%. The positive of CYFRA21-1 in adenocarcinoma group were significantly higher than the patients with lung squamous carcinoma group, but the difference was not statistically significant (P> 0.05).3. In 158 cases of stage IV non-small cell lung cancer patients had finish two cycles chemotherapy, the chemotherapy include GP, TP, NP, Pem+DDP(just use for who’s tissue types was not the squamous cell carcinoma). There were 15 cases with evaluate the efficacy of PR+CR,86 cases with evaluate the efficacy of SD and 4 cases with evaluate the efficacy of PD in the group with the lower level of CEA;There were 7 cases with evaluate the efficacy of PR+CR,35 cases with evaluate the efficacy of SD and 11 cases with evaluate the efficacy of PD in the group with the higher level of CEA. There were 14 cases with evaluate the efficacy of PR+CR,74 cases with evaluate the efficacy of SD and 2 cases with evaluate the efficacy of PD in the group with the lower level of CA125;There were 8 cases with evaluate the efficacy of PR+CR,47 cases with evaluate the efficacy of SD and 13 cases with evaluate the efficacy of PD in the group with the higher level of CA125. There were 15 cases with evaluate the efficacy of PR+CR,73 cases with evaluate the efficacy of SD and 3 cases with evaluate the efficacy of PD in the group with the lower level of CYFRA21-1;There were 7 cases with evaluate the efficacy of PR+CR,48 cases with evaluate the efficacy of SD and 12 cases with evaluate the efficacy of PD in the group with the higher level of CYFRA21-1.After the chemotherapy patients’curative effect in the group which level of CEA, CA125, CYFRA21-1 reduce is better than that is rise (P<0.05), the difference was statistically significant.4. In 158 cases of stage Ⅳ non-small cell lung cancer patients serum CEA is positive in 96 patients (60.8%), CA125 positive in 102 patients (64.6%), positive CYFRA21-1 in 111 patients (70.3%). The level of CEA is negative compared which is positive in 158 cases of stage Ⅳ non-small cell lung cancer patients, the median PFS was 6.5 months versus 5.9 months (P<0.05),the difference was statistically significant, the median OS was 13.2 months versus 8.8 months (P>0.05), there was no statistically significant difference. The level of CA125 is negative compared with which is positive, the median PFS was 7.8 months versus 5.1 months (P<0.05), the median OS was 16.1 months versus 9.2 months (P<0.05), the difference had statistical significance;The level of CYFRA21-1 is negative compared with which is positive,the median PFS was 7.8 months versus 5.3 months (P<0.05), the median OS was 16.2 months versus 9.4 months (P<0.05), the difference had statistical significance.5.They were divided into four group according to the positive number of three kinds of tumor markers, the negative group, one of the tumor markers was positive, two tumor markers was positive, three tumor markers was positive. Negative group has 13 cases (8.2%),1 tumor markers positive group with 36 cases (22.8%),2 tumor markers positive group of 54 cases (34.2%), patients with joint detection of three tumor markers positive 55 cases (34.8%). By compared between each group we found that the survival become longer with tumor markers positive number increasing, from negative to the three number of tumor markers positive group the median PFS was in 18.2 months and 7.0 months,5.2 months and 5.1 months (P<0.05), the difference was statistically significant, the median OS in 28.6 months,12.5 months and 12.5 months and 8.4 months (P<0.05), the difference was statistically significant. In the group which 2 tumor markers was positive, patients who CEA and CA125 positive were 13 cases, CEA and CYFRA21-1 positive were 16 cases, CA125 and CYFRA21-1 positive were 25 cases. In different of two members of tumor markers, the median PFS was 7.3 months versus 3.3 months versus 4.7 months (P>0.05), the median OS was 16.2 months versus 7.8 months versus 10.8 months (P>0.05), there were no statistically significant difference between two of tumor markers which was CEA,CA125, CYFRA21-1 were positive.Conclusion:1. For non-small cell lung cancer patients in stage Ⅳ, whether the level of CEA, CA125 is positive can predict the pathological type. CEA, CA125 positive suggests patients with lung adenocarcinoma;Positive suggests CYFRA21-1 patients with lung squamous carcinoma.2.For non-small cell lung cancer patients in stage Ⅳ, patients have better curative effect in group which the level of tumor marker is getting lower.3. For non-small cell lung cancer patients in stage Ⅳ, patients who the level of CEA, CA125, CYFRA21-1 is negative will have longer progression-free survival and overall survival, according to the positive of CEA, CA125, positive CYFRA21-1 can be preliminary judge the prognosis of patients.4. For non-small cell lung cancer patients in stage IV, it can improve the accuracy of prognostic and provide help for clinical diagnosis, the curative effect of chemotherapy and treatment by the joint detection of three tumor markers.