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EGFR gene mutation and association with carcinoembryonic antigen status in non-small cell lung cancer — a cross-sectional study

Lam Van Ngo1, Toan Khanh Nguyen1, Hung Duc Tran2, Uyen Tu Thi Nguyen1, Hien Thu Thi Tran1, Thanh Van Le1

Abstract

Introduction. Epidermal growth factor receptor (EGFR) gene mutations are an important aspect in the diagnosis and treatment of non-small cell lung cancer (NSCLC). Some studies suggest that serum CEA levels may serve as a predictor of the outcome of EGFR mutations. Therefore, we conducted a study to determine the prevalence of EGFR gene mutations and evaluate the prognostic value of serum CEA levels in predicting the frequency of EGFR gene mutations in NSCLC. 

Material and methods. From January 2018 to December 2022, a cross-sectional study was conducted on 384 NSCLC patients at the Nghe An Oncology Hospital, in Vietnam. EGFR mutations were analyzed using the real-time PCR method to determine the sensitivity and specificity of CEA values in predicting EGFR mutation traits by ROC curve analysis, and the association was assessed using univariate and multivariate logistic regression analyses. 

Results. The EGFR gene mutation rate in NSCLC is 41.9%. Among patients with genetic mutations, 50.9% had the del exon 19mutation, 34.8% had the L858R exon 21 mutation, 3.7% had rare exon 18 mutations, 5.6% had dual mutations, and 5.0% had exon 20 insertion mutations. The CEA cutoff value was determined to be 8.95. The sensitivity and specificity of CEA were 76.4% and 47.5%, respectively, and the area under the curve (AUC) was 0.627 (95% CI 0.571–0.683; p < 0.01). The EGFR gene mutation was found to be closely associated with the CEA subgroup ≥ 8.95 ng/mL (OR 2.54; 95% CI 1.57–4.13). 

Conclusions. This study shows a high incidence of EGFR mutations in NSCLC and suggests that CEA can aid in predicting the likelihood of these mutations. 

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References

  1. Hanna N, Robinson A, Temin S, et al. Therapy for Stage IV Non–Small-Cell Lung Cancer With Driver Alterations: ASCO and OH (CCO) Joint Guideline Update. J Clin Oncol. 2021; 39(9): 1040–1091.
  2. Nan X, Xie C, Yu X, et al. EGFR TKI as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer. Oncotarget. 2017; 8(43): 75712–75726.
  3. Rosell R, Carcereny E, Gervais R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012; 13(3): 239–246.
  4. Yang JCH, Wu YL, Schuler M, et al. Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol. 2015; 16(2): 141–151.
  5. Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009; 361(10): 947–957.
  6. Douillard JY, Ostoros G, Cobo M, et al. First-line gefitinib in Caucasian EGFR mutation-positive NSCLC patients: a phase-IV, open-label, single-arm study. Br J Cancer. 2014; 110(1): 55–62.
  7. Soria JC, Ohe Y, Vansteenkiste J, et al. Osimertinib in UntreatedEGFR-Mutated Advanced Non–Small-Cell Lung Cancer. N Engl J Med. 2018; 378(2): 113–125.
  8. Vu THa, Nguyen HT, Dao LK, et al. Effectiveness and Tolerability of First-Line Afatinib for Advanced EGFR-Mutant Non-Small Cell Lung Cancer in Vietnam. Asian Pac J Cancer Prev. 2021; 22(5): 1581–1590.
  9. Midha A, Dearden S, McCormack R. EGFR mutation incidence in non-small-cell lung cancer of adenocarcinoma histology: a systematic review and global map by ethnicity (mutMapII). Am J Cancer Res. 2015; 5(9): 2892–2911.
  10. Dang ATH, Tran VU, Tran TT, et al. Actionable Mutation Profiles of Non-Small Cell Lung Cancer patients from Vietnamese population. Sci Rep. 2020; 10(1): 2707.
  11. Mai K, Pham C, Nguyen L, et al. Prevalence and clinicopathological factors of the EGFR mutation status of Vietnamese non-small cell lung cancer patients. Journal of Clinical Oncology. 2019; 37(15_suppl): e13120–e13120.
  12. Shi Y, Au JSK, Thongprasert S, et al. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non-small-cell lung cancer of adenocarcinoma histology (PIONEER). J Thorac Oncol. 2014; 9(2): 154–162.
  13. Zhang YL, Yuan JQ, Wang KF, et al. The prevalence of EGFR mutation in patients with non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2016; 7(48): 78985–78993.
  14. Yang ZM, Ding XP, Pen L, et al. Analysis of CEA expression and EGFR mutation status in non-small cell lung cancers. Asian Pac J Cancer Prev. 2014; 15(8): 3451–3455.
  15. Jin Bo, Dong Yu, Wang Hm, et al. Correlation between serum CEA levels and EGFR mutations in Chinese nonsmokers with lung adenocarcinoma. Acta Pharmacol Sin. 2014; 35(3): 373–380.
  16. Pan JB, Hou YuH, Zhang GJ, et al. Correlation between EGFR mutations and serum tumor markers in lung adenocarcinoma patients. Asian Pac J Cancer Prev. 2013; 14(2): 695–700.
  17. Gao X, Wei C, Zhang R, et al. <sup>18</sup>F‑FDG PET/CT SUV<sub>max</sub> and serum CEA levels as predictors for EGFR mutation state in Chinese patients with non‑small cell lung cancer. Oncol Lett. 2020; 20(4): 61.
  18. Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual [Internet]. World Health Organization 1991. https://apps.who.int/iris/handle/10665/40062 (09.07.2023).
  19. Yatabe Y, Kerr KM, Utomo A, et al. EGFR mutation testing practices within the Asia Pacific region: results of a multicenter diagnostic survey. J Thorac Oncol. 2015; 10(3): 438–445.
  20. Han B, Tjulandin S, Hagiwara K, et al. EGFR mutation prevalence in Asia-Pacific and Russian patients with advanced NSCLC of adenocarcinoma and non-adenocarcinoma histology: The IGNITE study. Lung Cancer. 2017; 113: 37–44.
  21. Melosky B, Kambartel K, Häntschel M, et al. Worldwide Prevalence of Epidermal Growth Factor Receptor Mutations in Non-Small Cell Lung Cancer: A Meta-Analysis. Mol Diagn Ther. 2022; 26(1): 7–18.
  22. Zhou J, Song XB, He He, et al. Prevalence and Clinical Profile of EGFR Mutation In Non- Small-Cell Lung Carcinoma Patients in Southwest China. Asian Pac J Cancer Prev. 2016; 17(3): 965–971.
  23. Okamoto T, Nakamura T, Ikeda J, et al. Serum carcinoembryonic antigen as a predictive marker for sensitivity to gefitinib in advanced non-small cell lung cancer. Eur J Cancer. 2005; 41(9): 1286–1290.
  24. Gu J, Xu S, Huang L, et al. Value of combining serum carcinoembryonic antigen and PET/CT in predicting mutation in non-small cell lung cancer. J Thorac Dis. 2018; 10(2): 723–731.
  25. Cai Z. Relationship between serum carcinoembryonic antigen level and epidermal growth factor receptor mutations with the influence on the prognosis of non-small-cell lung cancer patients. Onco Targets Ther. 2016; 9: 3873–3878.
  26. Lv YL, Liu HB, Yuan DM, et al. Carcinoembryonic antigen in pleural effusion of patients with lung adenocarcinoma: a predictive marker for EGFR mutation. Transl Cancer Res. 2019; 8(4): 1027–1034.
  27. Wu Z, Dai Yu, Chen LA. The Prediction Of Epidermal Growth Factor Receptor Mutation And Prognosis Of EGFR Tyrosine Kinase Inhibitor By Serum Ferritin In Advanced NSCLC. Cancer Manag Res. 2019; 11: 8835–8843.