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Value of serum CEA and CA19-9 dynamic changes and trajectory modeling in prognosis assessment for non-small cell lung
Jing Huang1, Tianyun Qiao1, Huijie Meng2
1Department of Cardiothoracic Surgery, Air Force Hospital of the Southern War Zone of the Chinese People's Liberation Army, Guangzhou, China.
Objective:
To investigate the value of dynamic changes and trajectory fitting of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in the prognosis of non-small cell lung cancer (NSCLC).
Methods:
A retrospective analysis was conducted on 244 NSCLC patients treated in our hospital from January 2019 to December 2022. CEA and CA19-9 levels were collected before treatment and at 14 days, 28 days, 3 months, and 6 months post-treatment. Latent class growth models were used to analyze the change trajectories of the CEA and CA19-9 levels. Independent prognostic factors affecting overall survival (OS) in patients with NSCLC were identified using Cox regression analysis. A Nomogram model was developed to predict survival rates, with the classification performance evaluated using calibration curves and the area under the time-dependent ROC curve (AUC).
Results:
Both CEA and CA19-9 trajectories in NSCLC patients were categorized into two distinct patterns: a continuously decreasing pattern and a decreasing-then-increasing pattern. The Results from the multivariate COX regression and nomogram indicated that advanced age, smoking, advanced TNM stage, squamous cell carcinoma, and decreased CEA or CA19-9 levels before reaching stable state were factors associated with reduced OS in patients with NSCLC. The AUC values of the ROC curves for the 1-, 2-, and 3-year survival rates in the training set were 0.733, 0.863, and 0.840, respectively. The AUC values for the test set were 0.769, 0.726, and 0.760, respectively.
Conclusion:
Advanced age, smoking history, high TNM stage, squamous cell carcinoma, initial decrease followed by an increase in CEA, and initial decrease followed by an increase in CA19-9 are risk factors for reduced OS in patients with NSCLC. The clinical application of these factors enables the early identification of high-risk patients, facilitating early detection and intervention, and provides valuable data references for improving the prognosis of patients with NSCLC.
