Survival Model Established by Combined Serum Tumor Markers in Predicating the Effect of Erlotinib on Patients with Recurrent Non-small Cell Lung Cancer

• Main Authors: Lan Shao, Wei Hong, Yiping Zhang
• Format: Article
• Language: English
• Published: Third Party Medicine International Publishing Group Co. Limited 2013-12-01
• Series: Journal of International Translational Medicine
• Subjects: Non-small cell lung cancer; Erlotinib; Serum tumor marker; Prognostic factor; Predicative model
• Online Access: http://www.jitm.hk/EN/abstract/abstract89.shtml

Objective: To investigate the relationship of serum pulmonary surfactant-associated pretein (SP-D), transforming growth factor-α (TGF-α), matrix metalloproteinases-9 (MMP-9), tissue polypeptide specific antigen (TPS) and lung adenocarcinoma-related antigen (KL-6) with the effect and survival of treating advanced recurrent non-small cell lung cancer (NSCLC), and to establish a survival predication model. Methods: ELISA was applied to detect peripheral serum SP-D, TGF-α, MMP-9, TPS and KL-6 levels in 114 patients with recurrent NSCLC, and to analyze their relationship with the effect of erlotinib by combining with clinical symptoms, while one-way and multi-way analysis of variances were analyzed with Kaplan-Meier survival curve and Cox multi-way survival analysis model in order to establish the survival predication model. Results: The total effective rate and stability rate of erlotinib in 114 patients were 22.8% and 72.8% with progression-free survival (PFS) and 1-year survival rate being 5.13 months and 69.3%, respectively, and they were higher in SP-D > 110 ng/mL group than in ≤ 110 ng/mL group (P＝ 0.011, P ＝ 0.017). The stability rate in MMP-9 ≤ 535 ng/mL and TPS < 80 U/L groups were higher than in MMP-9 > 535 ng/mL (P ＝ 0.009) and TPS ≥80 U/L groups (P ＝ 0.002) respectively, while mPFS in SP-D > 110 ng/mL, MMP-9 ≤ 535 ng/mL, KL-6 < 500 U/mL and TPS < 80 U/L groups were longer than in SP-D ≤ 110 ng/mL (5.95 months vs. 3.25 months, P ＝0.009), MMP-9 > 535 ng/mL (5.83 months vs. 3.47 months, P ＝ 0.046), KL-6 ≥500 U/mL (6.03 months vs. 3.40 months, P ＝ 0.040) and TPS ≥80 U/L groups (6.15 months vs. 2.42 months, P＝ 0.014), respectively. Cox multi-way analysis showed that smoking history, wild EGFR genes, effective progression of terminal chemotherapy, free-of-rash during erlotinib treatment, increased LDH and TPS ≥80 U/L were independent risk factors for PFS. Additionally, patients were divided into 4 groups according to the predicative indexes in prognostic predication model: low risk group,medium-low risk group, medium risk group and high risk group, with PFS being 9.12, 6.88, 3.52 and 0.93 months, respectively, and there were significant differences (P ＝ 0.000). Conclusion: The establishment of prognostic survival model by detecting TPS level in serum tumor markers combined with clinical symptoms is of great significance in guiding and predicating erlotinib treatment on patients with recurrent NSCLC in clinic.