非小细胞肺癌患者血清淀粉酶A浓度与放射治疗生存时间及放射性肺炎相关性研究

目的 血清淀粉酶A(serum amyloid A,SAA)是一种非特异性急性时相反应蛋白,肿瘤患者血清中浓度可较健康人群明显增高.本研究旨在探索接受胸部放疗的非小细胞肺癌(non small cell lung cancer,NSCLC)患者的SAA浓度与总生存时间(overall survival,OS)和发生放射性肺炎相关性.方法 华中科技大学同济医院2012-07-15-2015-06-01共入组115例不可手术切除的或者局部晚期的NSCLC患者,并接受单纯胸部放疗或者同步放化疗.分别于放疗开始前(基线)、放疗2周、放疗4周及放疗完成后3个月内采血,并采用ELISA法检测SAA浓度.放疗完成后1年内根据CT-CAE 4.0标准记录患者放射性肺炎的发生情况.OS的计算方法为放疗开始至患者死亡或者至2016-03-31研究截止.采用SPSS 18.0及GraphPad Prism 5.0进行统计分析,检验水准α=0.05.结果 共114例患者进入数据分析,中位随访时间为17.1个月.全组患者基线SAA浓度中位值为101.4 μg/mL.＜和≥此中位浓度患者的中位OS分别为25.8和14.3个月,χ2 =5.519,P=0.019.多因素分析显示,性别、放疗剂量及基线SAA是OS延长的独立预后因素.放疗后SAA浓度(142.6 μg/mL)较放疗前明显降低(420.1 μg/mL),差异有统计学意义,t=3.50,P=0.001.放疗后出现≥2级和＜2级放射性肺炎患者的基线SAA平均浓度分别为476.7和113.0 pg/mL,两者相比差异有统计学意义,t=2.72,P=0.009.结论 在接受胸部放疗的局部晚期NSCLC患者中,SAA有可能作为预测放射性肺炎和预后的分子生物学指标.

Correlation between the serum amyloid A level and overall survival and radiation pneumonitis in non-small cell lung cancer patients receiving thoracic radiotherapy

OBJECTIVE Serum amyloid A (SAA) is one of the no,specific acute phase action proteins,and much higher level of SAA has been observed in patients with cancer than that in healthy control.This study was designed to investigate the the correlation between SAA level and the overall survival (OS) as well as radiation pneumonitis in non-small cell lung cancer patients receiving thoracic radiotherapy.METHODS A total of 115 locally advanced non-small cell lung cancer patients were eligible who were treated with thoracic radiotherapy or concurrent chemoradiotherapy.Serum samples were collected before the radiotherapy (baseline),2 weeks and 4 weeks during radiotherapy,and in 3 months after the end of the radiotherapy.Radiation pneumonitis was recorded in one year after radiotherapy by CTCAE 4.0.OS was defined as the interval between the date of treatment initiation and the date of death,or last follow-up for patients still alive.SPSS 18.0 and Graphpad Prism 5.0 software were used for statistical analysis,and α=0.05 was considered to be significant.RESULTS Totally 114 patients entered final analysis.The median baseline SAA level was 101.4 μg/mL,the median OS for patients with lower and higher than this level were 25.8 and 14.3 months,respectively,χ2=5.519,P=0.019.In multivariate analysis,gender,radiation dose and baseline SAA level were observed to be independent prognostic factors.The SAA level after radiotherapy was significantly decreased compared to the baseline (142.6 vs 420.1 μg/mL,t=3.50,P=0.001).The average SAA levels in patients with ≥grade 2 and ＜grade 2 radiation pneumonitis after radiotherapy were 476.7 μg/mL and 113.0 μg/mL,respectively,t=2.72,P=0.009.CONCLUSIONS SAA level may be a predictive biomarker for radiation pneumonitis and overall survival for patients with locally advanced nonsmall cell lung cancer receiving thoracic radiotherapy.