Carcinoembryonic antigen in pleural effusion of patients with lung adenocarcinoma: a predictive marker for EGFR mutation

Abstract

Background Carcinoembryonic antigen (CEA) can reflect tumor growth, recurrence and metastasis, and also predict the clinical efficacy of the epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI). In the present study, we investigated the association between CEA in serum and pleural effusion (PE) and EGFR mutations in patients with lung adenocarcinoma. Methods We retrospectively investigated 114 lung adenocarcinoma patients with malignant pleural effusion (MPE). CEA levels in serum and MPE were measured by immunoradiometric assay, we analysed the correlation between CEA and EGFR mutation status. Results Fifty-three cases had EGFR mutation (46.5%). EGFR mutations were more common in females, patients with high levels of PE (≥107.2 ng/mL) and serum CEA (≥87 ng/mL). There was no significant difference in EGFR mutation rate between in tumor tissue and PE samples (49.3% vs. 41.9%, P=0.440). The result of receiver operating characteristic (ROC) indicated that the cut off value of CEA in MPE was 107.2 ng/mL, which had the highest sensitivity (SEN) and specificity (SPE) for predicting EGFR mutation [SEN 66%, and SPE 62.3%, AUC =0.668, 95% confidence interval (CI): 0.569–0.767, P=0.025]. The combination of gender, smoking history, serum and MPE CEA level had a higher calculated AUC (0.718, 95% CI: 0.622–0.813, P=0.000). Moreover, multivariate analysis showed that CEA level in MPE but not in serum was confirmed as the only independent factor associated with EGFR gene mutation status (P=0.026) with an odds ratio of 2.885 (95% CI: 1.137–7.317). Conclusions MPE CEA can probably serve as a predictive marker for EGFR mutation in advanced lung adenocarcinoma. Combining gender, smoking history, and CEA has a relatively better predictive value. However, detecting EGFR mutations in lung adenocarcinomas is necessary for determining EGFR-TKI treatment in clinic.

Clinical impact of pleural fluid carcinoembryonic antigen on therapeutic strategy and efficacy in lung adenocarcinoma patients with malignant pleural effusion

“…In this study of MPEs secondary to lung adenocarcinoma, the EGFR mutation rates were more strongly associated with PF-CEA levels than with S-CEA levels, consistent with the findings of a previous study [ 12 ]. Although S-CEA levels were generally correlated with PF-CEA levels in most patients, some patients with low S-CEA levels had high PF-CEA levels (Supplementary Table 1 ).…”

“…Pleural fluid CEA (PF-CEA) levels are routinely measured during diagnostic thoracentesis in patients with suspected MPE and have significant clinical implications, suggesting MPE. Similar to S-CEA levels, one study demonstrated that PF-CEA levels could predict EGFR mutation status in patients with MPE [ 12 ]. Furthermore, EGFR mutations in lung adenocarcinomas may exhibit discordance between the primary tumor and corresponding metastases [ 13 , 14 ].…”

Correlation Between CEA Serum Level on NSCLC Patients with EGFR Mutation from Tissue and Plasma Sample

“…26 Research conducted by Yan Ling et al found the AUC value of 59% with a CEA cut off of 87 ng/ml, which means CEA has a weak assocation with EGFR mutations. 21 Using the new CEA cut-off, better results of PPV, LR+ and accuracy were obtained, but this cannot be used globally because it is only limited to this research. Another study with larger number of samples is needed to prove this hypothesis.…”

“…Another study with larger number of samples is needed to prove this hypothesis. 12,21 The limitation of this study is that it only examined the association of tissue and blood EGFR mutations with a single tumor marker, namely CEA.…”