Predictive Value of Preoperative Serum Tumor Marker Levels for Pathological Characteristics of Resected Lung Adenocarcinoma

Abstract

SESSION TITLE: Lung Cancer I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The aim of this study was to investigate the association between preoperative serum tumor marker levels and pathological characteristics of resected lung adenocarcinoma. METHODS: We retrospectively reviewed patients with lung adenocarcinoma who had undergone macroscopic complete resection from 2013 to 2015. Patients with multiple lung cancer other than adenocarcinoma, previous treatment history of lung cancer, or active other malignancies were excluded. Preoperative serum tumor marker levels (CEA, SCC, SLX, CYFRA, ProGRP, and NSE) and preoperative clinical factors (age, sex, smoking index, and tumor size) were analyzed with univariate analysis (Fisher’s exact test or the chi-square test) and multivariate logistic regression analysis to identify predictors for the pathological involvement (positive pleural effusion or lavage cytology, pleural involvement, pulmonary metastasis, lymph node involvement, lymphovascular involvement, and/or upstaging) or the poor prognostic subtypes (solid or micropapillary predominant adenocarcinoma). For the significant factors, optimal cutoff points were determined with a receiver operating characteristic (ROC) analysis. RESULTS: Of a total of consecutive 183 patients, 100 were male and 83 were female, and the median age was 70 years. On pathologic diagnosis, 4 (2%) patients had positive pleural effusion or lavage cytology, 36 (20%) had pleural involvement, 6 (3%) had pulmonary metastasis, 20 (11%) had lymph node involvement, 39 (21%) had lymphovascular involvement, and 43 (23%) showed upstaging. In total, 72 patients (39%) had the pathological involvement. In the subtypes of adenocarcinoma, 17 (9%) patients had solid or micropapillary predominant adenocarcinoma, 129 (71%) had invasive adenocarcinoma other than these 2 subtypes, and 37 (20%) had AIS or MIA. Both univariate and multivariate analysis identified CEA and tumor size for the pathological involvement and smoking index and SLX for the poor prognostic subtypes as significant predictors. Of patients with CEA ≥5.3 ng/ml or SLX ≥34 U/ml which were determined by the ROC analysis, 33 of 57 (58%) and 9 of 39 (23%) patients had the pathological involvement or the poor prognostic subtypes, respectively. CONCLUSIONS: Preoperative higher CEA and SLX may predict pathological characteristics of lung adenocarcinoma, such as presence of pathological involvement and poor prognostic subtypes. CLINICAL IMPLICATIONS: Preoperative serum tumor marker levels should be considered for deciding surgical treatment strategy of lung adenocarcinoma. DISCLOSURE: The following authors have nothing to disclose: Terumoto Koike, Akihiko Kitahara, Seijiro Sato, Takehisa Hashimoto, Shin-ichi Toyabe, Masanori Tsuchida No Product/Research Disclosure Information