关键词: 小细胞肺癌, 胃泌素释放肽前体, 神经元特异性烯醇化酶, 治疗结果, 预后, 影响因素分析

Abstract: Background　Small cell lung cancer （SCLC） is highly invasive，characterized by rapid tumor doubling time，early metastasis，easy recurrence，and poor prognosis.At the time of diagnosis，only about 30% of patients are in limited disease.Although SCLC is highly sensitive to radiotherapy and chemotherapy，some patients will develop drug resistance and tumor proliferation after a period of treatment.Therefore，to find out the factors affecting the response and outcome following treatment in SCLC patients will play a certain role in stratified management and prognosis improvement of these patients.Objective　To analyze the serum levels of NSE and Pro-GRP in the evaluation of response and outcome following initial chemotherapy in SCLC patients.Methods　From July 2015 to July 2016，103 patients with SCLC confirmed by pathological examination were recruited from Department of Respiratory Medicine，Changhai Hospital.All of them received initial chemotherapy for 4 to 6 cycles.Serum NSE and Pro-GRP levels were measured before and after chemotherapy.The patients were followed up as of 2017-07-31，and the progression-free survival（PFS） were recorded.Results　Among the 103 patients，7 （6.8%） had complete response （CR），18 （17.5%） had partial response （PR），53 （51.4%） had stable disease （SD），and 25 （24.3%） had disease progression （PD）．Compared with baseline，patients with CR and PR had decreased average serum NSE and Pro-GRP levels after the chemotherapy，so did those with SD（P<0.05）．But there were no significant differences in average pre- and post-chemotherapy NSE and Pro-GRP levels in PD patients （P>0.05）．The average levels of NSE and Pro-GRP in CR+PR，SD，and PD groups were significantly different after chemotherapy （P<0.05）．Spearman rank correlation test revealed that pre-chemotherapy NSE and Pro-GRP levels had no correlations with treatment response （rs=0.019，P=0.845；rs=0.171，P=0.086），but postchemotherapy NSE and Pro-GRP levels did （rs=0.342，P<0.001；rs=0.350，P<0.001）．The distribution of responses to initial chemotherapy differed significantly between those with NSE< upper limit of normal（ULN） and those with NSE≥ULN （P<0.05）．But the distribution of responses to initial chemotherapy did not vary significantly between those with Pro-GRP < ULN and those with Pro-GRP ≥ULN （P<0.05）．The PFS changed obviously according to tumor stage，metastasis status，levels of postchemotherapy NSE and Pro-GRP（P<0.05）．Multivariate survival analysis using Cox's regression model showed that tumor stage 〔HR=2.19，95%CI （1.29，3.72）〕 and postchemotherapy NSE level 〔HR=2.67，95%CI （1.62，4.44）〕 were prognostic factors of SCLC patients （P<0.05）．Conclusion　Postchemotherapy NSE and Pro-GRP levels can well monitor the response to chemotherapy in SCLC patients.In particular，postchemotherapy NSE level may also be used for predicting the outcome.

Key words: Small cell lung carcinoma, Pro-gastrin releasing peptide, Neuron specific enolase, Treatment outcome, Prognosis, Root cause analysis