P3.16-051 Implications of Preoperative Serum Tumor Levels on Pathological Characteristics in Patients with Lung Adenocarcinoma

Abstract

Although preoperative serum tumor marker levels, such as carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) are often evaluated in non-small cell lung cancer patients, the implication of these levels are still unknown. This study examined the predictive effect of preoperative tumor marker levels on pathological characteristics of lung adenocarcinoma. We retrospectively reviewed patients with lung adenocarcinoma who underwent macroscopic complete resection. The pathological metastasis and/or involvement was defined that positive pleural effusion or lavage cytology, pleural involvement, pulmonary metastasis, lymph node metastasis, and/or lymphovascular involvement were identified on pathological examination. To identify predictors for the pathological metastasis and/or involvement, tumor markers (CEA, SCC, Sialyl Lewisx-1 [SLX], cytokeratin-19 fragments [CYFRA], neuron-specific enolase [NSE], and pro-gastrin-releasing peptide [ProGRP]), and demographic and clinical factors were analyzed by a univariate analysis and multivariate logistic regression analysis. For the significant tumor markers, optimal cutoff points were determined with a receiver operating characteristic analysis. Of the 263 eligible patients, 138 were male and 125 were female. The median age was 70 years. The median preoperative CEA, SCC, SLX, CYFRA, NSE, and ProGRP levels were 3.7 ng/ml, 0.8 ng/ml, 28 U/ml, 1.8 ng/ml, 8.4 ng/ml, and 46.9 pg/ml, respectively. According to the 7th edition of the TNM classification, 186 patients (71%) had c-stage IA disease, 48 (18%) had c-stage IB disease, 26 (10%) had c-stage II disease, and 3 (1%) had c-stage III disease. Positive pleural effusion, positive pleural lavage cytology, pleural involvement, pulmonary metastasis, lymph node metastasis, lymphatic permeation, and vascular invasion were identified in 3 (1%), 4 (2%), 48 (18%), 9 (3%), 28 (11%), 20 (8%), and 35 patients (13%), respectively, and in total, 83 patients (32%) developed the pathological metastasis and/or involvement. The univariate analysis identified CEA, smoking index, size, solid size, and c-stage as significant predictors. A multivariate analysis revealed CEA (OR: 1.113, p=0.005) and solid size (OR: 1.052, p<0.001) as significant predictors. The optimal cutoff point was determined as 6.0 ng/ml for the preoperative CEA, and 35 of the 63 patients (56%) with ≥6.0 ng/ml of CEA developed the pathological metastasis and/or involvement whereas 48 of the 200 patients (24%) with <6.0 ng/ml of CEA developed pathological metastasis and/or involvement. Our results suggested the predictive effect of the high preoperative CEA level on pathological metastasis and involvement in patients with lung adenocarcinoma, and thus, we may consider preoperative CEA to decide surgical procedure for these patients, such as the extent of pulmonary resection and lymphadenectomy.