The Value Of Dynamic Detection Of The Change Rate Of ProGRP Levels Before And After Chemotherapy In The Evaluation Of The Efficacy And Prognosis Of Extensive-stage Small Cell Lung Cancer

Background and purpose: Lung cancer is the most common type of malignant tumor in the world,of which small cell lung cancer（SCLC）accounts for about 15%of the total number of lung cancers.Its unique natural history and high degree of malignancy make the current treatment effects unsatisfactory.We hope to establish a non-invasive,convenient,and effective therapeutic evaluation model and exploration of prognostic predictors based on dynamic detection of patient tumor markers:precursor gastrin-releasing peptide（ProGRP）levels,to explore first-line chemotherapy in patients with extensive-stage SCLC at different stages the value of the change rate of serum ProGRP levels before and after in the evaluation of imaging tumor disease control（DC）and the value of prognosis and survival prediction.Looking for a model to further improve the rate of change of ProGRP level to evaluate the efficacy.Materials and methods: The clinical data of pathologically diagnosed patients with extensive-stage SCLC who were admitted to Zhejiang Provincial People’s Hospital from April 1,2016 to June 30,2021 were retrospectively collected,and their progression-free survival（PFS）was followed up.Serum ProGRP levels were collected within 1 week before chemotherapy,within 1 week before the second cycle of chemotherapy,and within 1 week before the third cycle of chemotherapy.The effects of gender,age,weight loss,smoking index,ECOG PS score,chemotherapy regimen and ProGRP level change rate at different stages on the efficacy evaluation and prognosis evaluation of extensive-stage SCLC were analyzed.The spss25.0statistical software was used,and the categorical data were expressed by the number of cases and the composition ratio.The measurement data were compared by the χ2test or Fisher’s exact test to compare the differences between the two groups.The ROC curve was drawn by Med Calc software,and the prognostic factors of patients were analyzed by Logistic,Kaplan-meier method and COX multivariate risk regression model.P<0.05 was statistically significant.Results: 1.The area under the ROC curve of the rate of change of ProGRP1 to evaluate the efficacy of DC was 0.946（P<0.01）,the threshold was 7.14%,and the sensitivity and specificity were both ≥90%.Univariate logistic regression and multivariate logistic regression analysis further confirmed the role of ProGRP1 change in the evaluation of DC（P<0.01）.Survival analysis showed that the PFS of patients with positive ProGRP1 changes was significantly shorter than that of patients with negative changes（median values were 2.3 months and 7.0 months,respectively,P < 0.05）.COX multivariate risk regression analysis suggested that ProGRP1 was an independent factor in predicting PFS in patients with extensive-stage SCLC（P<0.05）.2.The area under the ROC curve of the rate of change of ProGRP2 to evaluate the efficacy of DC was 0.925（P<0.01）,the threshold was 18.07%,and the sensitivity and specificity were both ≥80%.Univariate logistic regression and multivariate logistic regression analysis further confirmed the role of ProGRP2 changes in the evaluation of DC（P <0.01）.Survival analysis showed that the PFS of patients with positive ProGRP2 changes was significantly shorter than that of patients with negative changes（median values were 2.3 months and 7.0 months,respectively,P < 0.05）.COX multivariate risk regression analysis suggested that ProGRP2 was an independent factor for predicting PFS in patients with extensive-stage SCLC（P<0.05）.3.There was no significant difference in the efficacy of the combined evaluation of the DC.The single index in the evaluation of the change rate of ProGRP1 and ProGRP2 were also no difference（P>0.05）.Conclusions: 1.In patients with extensive-stage SCLC,the change rate of ProGRP1 and ProGRP2 can effectively evaluate the efficacy of chemotherapy,and can be used as an important auxiliary tool for imaging evaluation.2.Combined evaluation does not improve the evaluation performance,and there is no difference between the efficacy of ProGRP1 change rate and ProGRP2 change rate in evaluating efficacy.3.ProGRP changes can also effectively predict the PFS of patients,which is beneficial to the prognosis evaluation of patients.