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血清细胞角蛋白19在预测进展期非小细胞肺癌患者化疗疗效及预后中的临床意义
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血清细胞角蛋白19在预测进展期非小细胞肺癌患者化疗疗效及预后中的临床意义
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血清细胞角蛋白19在预测进展期非小细胞肺癌患者化疗疗效及预后中的临床意义
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Journal Article
血清细胞角蛋白19在预测进展期非小细胞肺癌患者化疗疗效及预后中的临床意义
2010
Overview
背景与目的由于RECIST（Response Evaluation Criteria in Solid Tumors, RECIST）标准不能对存活肿瘤组织进行检测,也不能对所有无法测量病灶的非小细胞肺癌（non-small cell lung cancer, NSCLC）患者的疗效进行准确评估,本研究通过检测进展期NSCLC患者化疗前后血清细胞角蛋白19片段（cytokeratin 19 fragment, CYFRA21-1） 表达水平的变化以评价其在预测进展期NSCLC患者化疗疗效及预后中的临床价值。方法采用全自动生化分析仪电化学发光免疫法检测112例初治的NSCLC患者化疗前和化疗2周期后血清CYFRA21-1表达水平的变化,应用受试者特征工作曲线（receiver operating characteristics curve, ROC）评价血清CYFRA21-1反应在诊断影像学缓解（objective response, OR）中的效能及其与预后的相关性。结果经一线铂类为基础的两药联合方案化疗2周期后,血清CYFRA21-1水平较化疗前基线水平明显下降。80例可评价影像学和血清学疗效的患者中,26.3%（21/80）的患者达到影像学OR。化疗2周期后40.0%（32/80）的患者血清CYFRA21-1水平下降≥60%（血清CYFRA21-1反应）。血清CYFRA21-1反应与影像学OR之间有明显的统计学相关性（P〈0.001）。所有患者的中位生存期为9.9个月,血清CYFRA21-1水平下降≥60%患者的生存期明显长于CYFRA21-1水平下降〈60%的患者（12.3个月 vs 8.9个月,P〈0.001）。单因素分析结果显示,血清CYFRA21-1基线水平、CYFRA21-1反应、PS评分及影像学OR是影响生存期的重要预后因素。Cox多因素生存分析证实,仅血清CYFRA21-1基线水平、CYFRA21-1反应及PS评分是影响预后生存期的独立因素,而OR则与预后无关。结论血清CYFRA21-1水平可敏感地反映影像学肿瘤体积大小的变化,可能是评价进展期NSCLC患者化疗疗效的替代指标,同时也是预测预后生存期的可信指标。
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