The Prediction Of Epidermal Growth Factor Receptor Mutation And Prognosis Of EGFR Tyrosine Kinase Inhibitor By Serum Ferritin In Advanced NSCLC
Authors Wu Z, Dai Y, Chen LA
Received 17 May 2019
Accepted for publication 24 August 2019
Published 7 October 2019 Volume 2019:11 Pages 8835—8843
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Nicola Ludin
Peer reviewer comments 2
Editor who approved publication: Dr Chien-Feng Li
Zhen Wu, Yu Dai, Liang-An Chen
Respiratory Department, Chinese PLA General Hospital, Beijing, People’s Republic of China
Correspondence: Liang-An Chen
Respiratory Department of Chinese PLA General Hospital, IMB 16th Floor, Room 16-104 28, Fuxing road, Haidian district, Beijing 100853, People’s Republic of China
Tel +86 10 6693 6184
Purpose: To investigate the association between level of serum ferritin (SF) and epidermal growth factor receptor (EGFR) mutations and to analyse the impact of SF level on survival times in advanced non-small-cell lung cancer (NSCLC) patients taking EGFR tyrosine kinase inhibitors (EGFR-TKIs).
Methods: A total of 301 patients who were admitted to the Chinese PLA general hospital from August 2015 to August 2017 were enrolled. The association between tumour markers, including SF, CEA, and EGFR mutation, and their impact on the prognosis of patients taking EGFR-TKIs was investigated.
Results: In all patients, the percentage of patients with EGFR mutations was 52.5% (158/301). EGFR mutations were more likely to be detected in younger (<60 years old), adenocarcinoma patients, non-smokers, women, CEA≥5 μg/L and serum ferritin ≥129 μg/L for females or ≥329 μg/L for males (p<0.05). Increased serum ferritin was an independent factor for predicting EGFR mutations (odds ratio (OR)=4.593, 95% CI (2.673–7.890); P <0.001), and an area under curve (AUC) of 0.711 was shown to predict EGFR mutations with a sensitivity of 81.7% and a specificity of 65.2% in women. Sensitivity increased to 91.1% when combining SF and CEA in all patients. SF was also an independent factor (HR=3.531, 95% CI (2.288–5.448); P<0.001) for predicting progression-free survival (PFS) of patients on EGFR-TKIs, analysed by a Cox proportional hazard model, as PFS was shorter in patients with higher SF (15.0 mo. (SF < 129 μg/L for females or <329 for males) vs 10.0 mo. (129–258 μg/L for females or 329–658 μg/L for males) vs 7.3 mo. (>258 μg/L (>258 μg/L for females or >658 μg/L for males) p<0.001).
Conclusion: SF was a significant predictor of EGFR mutation with moderate diagnostic accuracy, and combining SF and CEA increased the diagnostic sensitivity and specificity for EGFR mutations. SF was also useful for predicting survival in EGFR-TKIs.
Keywords: EGFR mutation, serum ferritin, EGFR-TKI, lung cancer, prognosis
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