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Clinical Studies

Trajectory patterns and cumulative burden of CEA during follow-up with non-small cell lung cancer outcomes: A retrospective longitudinal cohort study

British Journal of Cancer (2024)Cite this article

Subjects

Abstract

Background

Previous studies of non-small cell lung cancer (NSCLC) focused on CEA measured at a single time point, ignoring serial CEA measurements.

Methods

This retrospective cohort included 2959 patients underwent surgery for stage I-III NSCLC. CEA trajectory patterns and long-term cumulative CEA burden were evaluated using the latent class growth mixture model.

Results

Four CEA trajectory groups were identified, named as low-stable, decreasing, early-rising and later-rising. Compared with the low-stable group, the adjusted hazard ratios associated with death were 1.27, 4.50, and 3.68 for the other groups. Cumulative CEA burden were positively associated with the risk of death in patients not belonging to the low-stable group. The 5-year overall survival (OS) rates decreased from 62.3% to 33.0% for the first and fourth quantile groups of cumulative CEA burden. Jointly, patients with decreasing CEA trajectory could be further divided into the decreasing & low and decreasing & high group, with 5-year OS rates to be 77.9% and 47.1%. Patients with rising CEA trajectory and high cumulative CEA were found to be more likely to develop bone metastasis.

Conclusions

Longitudinal trajectory patterns and long-term cumulative burden of CEA were independent prognostic factors of NSCLC. We recommend CEA in postoperative surveillance of NSCLC.

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Fig. 1: Longitudinal CEA trajectory patterns and non-small cell lung cancer outcomes.
Fig. 2: CEA joint groups defined by CEA trajectory patterns and cumulative CEA burden with non-small cell lung cancer outcomes.

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Data availability

The data underlying this article cannot be shared publicly due to individuals’ privacy that participated in the study. The data will be shared at a reasonable request to the corresponding author.

Code availability

All statistical analyses were performed using R software (version 4.1.3), with two-sided statistical significance set at a P value < 0.05. LCGMM and JLCMM were implemented with package “lcmm” (version 1.9.2). The χ2 proportion test was performed with Harrell’s R package “rms” (version 6.5.0).

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Acknowledgements

This study is a joint effort of many investigators and staff members, and their contribution is gratefully acknowledged. We especially thank all patients who participated in this study.

Funding

This work was funded by the National Natural Science Foundation of China [grant numbers [82222064, 82073569], Shandong University Distinguished Young Scholars, the Outstanding Youth Science Foundation of Yunnan Basic Research Project [202101AW070001], the Reserve Talent Project for Young and Middle-aged Academic and Technical Leaders [2012005AC160023], the Key Science Foundation of Yunnan Basic Research [202101AS070040], and the Innovative Research Team of Yunnan Province [202405AS350016].

Author information

Author notes

  1. These authors contributed equally: Chunxia Li, Lizhu Liu.

Authors and Affiliations

  1. Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China

    Chunxia Li, Bingbing Fan, Jiali Lv & Tao Zhang

  2. Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, 650118, China

    Lizhu Liu, Ruimin You, Yanli Li & Zhenhui Li

  3. Department of Colorectal Surgery, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, 650118, China

    Hongjiang Pu

  4. Department of Clinical Laboratory Medicine, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, 650118, China

    Ming Lei

  5. School of Public Health, Kunming Medical University, Kunming, Yunnan, 650500, China

    Mengmei Liu & Guanghong Yan

  6. Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, Yunnan, 650500, China

    Dingyun You

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  1. Chunxia Li
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Contributions

LC, YD, LZ, ZT did the concept and study design. LC, LZ, ZD, PX, PH and LM participated in the collection and assembly of data. LC, YD, LZ, ZT designed the latent class growth mixed model. LC, YD, LZ, ZT, FB, LJ did the statistical analysis and gave interpreted the results. LC draughted the manuscript, and ZT, LZ revised the manuscript. All authors reviewed and commented on the manuscript, and approved its final submission.

Corresponding authors

Correspondence to Zhenhui Li, Dingyun You or Tao Zhang.

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The authors declare no competing interests.

Ethics approval and consent to participants

This retrospective study was approved by the ethics committee of Yunnan Cancer Hospital. The requirement for informed consent was waived by the board, owing to the study’s retrospective nature. All the patient data in the survey were anonymized.

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Li, C., Liu, L., You, R. et al. Trajectory patterns and cumulative burden of CEA during follow-up with non-small cell lung cancer outcomes: A retrospective longitudinal cohort study. Br J Cancer (2024). https://doi.org/10.1038/s41416-024-02678-8

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  • DOI: https://doi.org/10.1038/s41416-024-02678-8

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