The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical impact of pleural fluid carcinoembryonic antigen on therapeutic strategy and efficacy in lung adenocarcinoma patients with malignant pleural effusion

  • Jaehee Lee (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Deok Heon Lee (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University) ;
  • Ji Eun Park (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Yong Hoon Lee (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Sun Ha Choi (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Hyewon Seo (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Seung Soo Yoo (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Shin Yup Lee (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Seung-Ick Cha (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Jae Yong Park (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Chang Ho Kim (Department of Internal Medicine, School of Medicine, Kyungpook National University)
  • Received : 2023.07.22
  • Accepted : 2023.12.01
  • Published : 2024.03.01
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Abstract

Background/Aims: Epidermal growth factor receptor (EGFR) mutation is important in determining the treatment strategy for advanced lung cancer patients with malignant pleural effusion (MPE). Contrary to serum carcinoembryonic antigen (S-CEA) levels, the associations between pleural fluid CEA (PF-CEA) levels and EGFR mutation status as well as between PF-CEA levels and treatment efficacy have rarely been investigated in lung adenocarcinoma patients with MPE. Methods: This retrospective study enrolled lung adenocarcinoma patients with MPE and available PF-CEA levels and EGFR mutation results. The patients were categorized based on PF-CEA levels: < 10 ng/mL, 10-100 ng/mL, 100-500 ng/mL, and ≥ 500 ng/mL. The association between PF-CEA levels and EGFR mutation status as well as their therapeutic impact on overall survival was compared among the four groups. Results: This study included 188 patients. PF-CEA level was found to be an independent predictor of EGFR mutation but not S-CEA level. The EGFR mutation rates were higher as the PF-CEA levels increased, regardless of cytology results or sample types. Among EGFR-mutant lung adenocarcinoma patients receiving EGFR-tyrosine kinase inhibitor (TKI) treatment, those with high PF-CEA levels had significantly better survival outcomes than those with low PF-CEA levels. Conclusion: High PF-CEA levels were associated with high EGFR mutation rate and may lead to a favorable clinical outcome of EGFR-TKI treatment in EGFR-mutant lung adenocarcinoma patients with MPE. These findings highlight the importance of actively investigating EGFR mutation detection in patients with suspected MPE and elevated PF-CEA levels despite negative cytology results.

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References

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