Background: Increased serum neuron-specific enolase (NSE) level was found in a substantial proportion (30%-69%) of patients with non-small-cell lung cancer (NSCLC), but little was known about the clinical properties of NSE in NSCLC. Objective: We aimed to assess the level of serum NSE to predict prognosis and treatment response in patients with advanced or metastatic non-neuroendocrine NSCLC. Methods: We retrospectively analysed 363 patients with advanced and metastatic NSCLC between January 2011 and October 2016. The serum NSE level was measured before initiation of treatment. Results: Patients with high NSE level (≥26.1 ng/ml) showed significantly shorter progression-free survival (PFS) (5.69 months vs 8.09 months; P = 0.02) and significantly shorter overall survival (OS) than patients with low NSE level (11.41 months vs 24.31 months; P = 0.01). NSE level was an independent prognostic factor for short PFS (univariate analysis,hazard ratio [HR] = 2.40 (1.71-3.38), P < 0.001; multivariate analysis, [HR] = 1.81 (1.28-2.56), P = 0.001) and OS (univariate analysis,[HR] = 2.40 (1.71-3.37), P < 0.001; multivariate analysis, [HR] = 1.76 (1.24-2.50), P = 0.002). Conclusion: The survival of NSCLC patients with high serum NSE level was shorter than that of NSCLC patients with low serum NSE levels. Serum NSE level was a predictor of treatment response and an independent prognostic factor.

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