| BackgroundLung cancer is one of the most common malignant cancers in this world,which is a sever threat to human lives and health.Small cell lung cancer(SCLC)is the most malignant one.Elevated serum tumor markers are very common in patients with lung cancer.The levels of markers reflect the instant tumor state.The ideal marker should be expert in helping diagnosis,evaluating the curative effect,monitoring relapse,and predicting the prognosis.The study of tumor markers occupies an important place in oncology.ObjectiveThis study was to investigate the expression of serum lactate dehydrogenase and neuron-specific enolase in patients with SCLC and the relationship of chemotherapy-induced changes of LDH and NSE levels and the response to chemotherapy.Another important purpose of this paper was exploring the correlation between LDH and NSE levels and prognosis of SCLC.MethodsThis study retrospectively analyzed the data of totally 104 patients with small cell lung cancer,whose first diagnoses were at Qilu Hospital from Jan.2009 to Jan.2014.All of the diagnoses were confirmed by the pathological outcomes.We collected the basic information of involved patients,including their names,ages,genders,history of smoke,personal status,tumor staging,metastatic sites,and serum LDH and NSE levels before and after chemotherapy.The PFS and OS of patients were collected by call visits or searching medical records.The response evaluation criteria in solid tumors(RECIST)was adopted in the assessment of the therapeutic effect.Find the correlation between chemotherapy-induced changes of markers and the response to treatments.The normal ranges of LDH and NSE levels were 120-230U/L and<13ng/ml,respectively.Those normal ranges stratified patients into 2 subgroups,namely Elevated Group and Normal Group.Compare the prognoses of these groups.All statistical analyses were processed by SPSS.23 software.P values less than 0.05 were considered statistically significant.Results1.The number of patients with elevated pre-sLDH was 51(49%).The elevated LDH levels were significantly correlated with tumor staging(P=0.00]).PS score(P<0.001)and liver metastasis(P=0.016).The cases of elevated pre=sNSE level were 91,with a high pelrcent of-87.6%.The elevated NSE level had statistical significance with PS score(P=0.015)and tumor staging(P=0.O16).2.The mean pre-sLDH level was 262±169U/L,and mean post-sLDH level was 200±82U/L.The P value was less than 0.001.The mean NSE level dropped from 51±48ng/ml to 19±15ng/ml after 2 courses of chemotherapy.The P value was also less than 0.001.There were significant correlations in both of them.3.After 2 courses of chemotherapy,the chemotherapy-induced changes of LDH and NSE had statistically significant dif’ferences in Remission group and Stable group(P<0.01).while no statistical diff-erences were found in Progression group(P=0.297 an P=.358)4.The relationship between LDH levels and prognosis1)The correlation between pre-sLDH levels and survival:the median OS and PFS of normal pre-sLDH group were16.2 months and 9.3 months,respectively;while the median OS and PFS of elevated pre-sLDH group were 12.1 months and 7.0 months,respectively.Statistical differences of survival were found in two groups.2)The correlation between post-sLDH levels and survival:the median OS and PFS of normal post-sLDH group were 14.7 months and 8.6 months,respectively,while the median OS and PFS of elevated post-sLDH group were 12.0 months and 6.5months,respectively.Statistical differences of survival were found in two groups.3)The correlation between pre-sNSE levels and survival:the median OS and PFS of normal pre-sNSE group were 18.7 months and 11.4 months,respectively,while the median OS and PFS of elevated pre-sNSE group were 13.7 months and 7.6 months,respectively.Statistical differences of survival were found in two groups.4)The correlation between post-sNSE levels and survival:the median OS and PFS of normal post-sNSE group were 16.0 months and 9.0 months,respectively,patients with elevated post-NSE had a shorter median OS(13.1 months)and PFS(7.3 months),and statistical differences were observed.5.The correlation between pre-sLDH/pre-sNSE and survival in LD/ED1)The median OS of normal pre-sLDH group and elevated group in limited disease were 17.000±0.370 months and 13.300±0.054 months,respectively.Statistical difference was observed(P= 0.003).In the NSE group,the median OS were 18.700±0.773 in normal group and 15.000±0.629 months in elevated group.respectively.There was statistical difference(P= 0.024).2)The median OS of normal pre-sLDH group and elevated group in extensive disease were 12.300±0.773 months and 11.100±0.441 months,respectively.No statistical difference was observed(P= 0.237).In the NSE group,the median OS were 13.100±0.508 and 11.700±0.404 months,respectively.There was no statistical difference(P= 0.184).6.The univariate model showed that gender,age,and history of smoke were not significantly correlated with survival,while PS score(P=0.019).tumor staging(P<0.001),pre-sLDH(P<0.001),post-sLDH(P=0.011),pre-sNSE(P=0.002)and post-sNSE(P=0.003)were significantly correlated with survival.The multivariate model demonstrated that tumor staging(P=0.002)was an independent factor for survival.Conclusion:PS score and tumor staging are prognostic influencing factors of small cell lung cancer.Tumor staging was an independent factor for survival.The chemotherapy-induced changes of LDH and NSE in patients with SCLC were capable of evaluating the chemotherapy effect;pre-sLDH,pre-sNSE and post-sNSE were also capable of evaluating the chemotherapy effect.The pre-sLDH/post-sLDH and pre-sNSE/post-sNSE were prognostic factors but not independent prognostic factors,and the prognostic value only existed in limited disease. |
