Value of serum tumor markers for predicting EGFR mutations and positive ALK expression in 1089 Chinese non-small-cell lung cancer patients: A retrospective analysis.
PURPOSE
The role of serum tumor markers (STMs) in the modern management of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations in lung cancer remains poorly described. In this study, we investigated whether STMs could be a valuable noninvasive tool to predict EGFR mutations and ALK positivity in non-small-cell lung cancer (NSCLC) patients.


EXPERIMENTAL DESIGN
We retrospectively reviewed and included 1089 NSCLC patients who underwent EGFR or ALK mutation testing and STMs measurement prior to treatment. The differences in several clinical characteristics and STMs between the subgroups were analyzed. Multivariate logistic regression analysis was performed to identify predictors of EGFR mutations and ALK positivity.


RESULTS
EGFR mutations were found more frequently in females (63.11%), never-smokers (59.69%), and those with lung adenocarcinoma (ADC) (53.87%). Negative carbohydrate antigen (CA) 125, ferritin (FERR), squamous cell carcinoma antigen (SCC), and soluble fragment of cytokeratin 19 (CYFRA 21-1) levels were significantly associated with EGFR mutations (p < 0.05). Multivariate analysis demonstrated that ADC, never-smoker status, and negative CA 125 and SCC results were predictors of EGFR mutations (p < 0.05). The receiver operating characteristic (ROC) curve yielded an area under the curve (AUC) of 0.715 (95% confidence interval [CI]: 0.673-0.758) for the combination of the four factors. Positive ALK expression was found more frequently in younger patients (median age: 49 years), females (8.40%), never-smokers (8.82%), and those negative for carcinoembryonic antigen (CEA) (8.02%). Multivariate analysis demonstrated that younger age and never-smoker status were the only independent predictors of ALK positivity (p < 0.05). The ROC curve yielded an AUC of 0.760 (95% CI: 0.677-0.844) for the combination of these two factors.


CONCLUSION
STMs are associated with mutant EGFR status and could be integrated with other clinical factors to enhance the ability to distinguish EGFR mutation status among NSCLC patients. For ALK-positive patients, younger age and never-smoker status could predict the mutation status, whereas STMs could not.
['Wang|Sufei|S|', 'Ma|Pei|P|', 'Ma|Guanzhou|G|', 'Lv|Zhilei|Z|', 'Wu|Feng|F|', 'Guo|Mengfei|M|', 'Li|Yumei|Y|', 'Tan|Qi|Q|', 'Song|Siwei|S|', 'Zhou|E|E|', 'Geng|Wei|W|', 'Duan|Yanran|Y|', 'Li|Yan|Y|', 'Jin|Yang|Y|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000077548:Anaplastic Lymphoma Kinase D044466:Asians D014408:Biomarkers, Tumor D002289:Carcinoma, Non-Small-Cell Lung D066246:ErbB Receptors D005260:Female D006801:Humans D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D009154:Mutation D011237:Predictive Value of Tests D012189:Retrospective Studies
Serum tumor markers Non-small-cell lung cancer Epidermal growth factor receptor Anaplastic lymphoma kinase