食管鳞癌螺旋CT征象与Cyfra21-1表达间关系的研究

Correlation between spiral CT features and expression of Cyfra21-1 in patients with esophageal squamous cell carcinoma

目的探讨食管鳞癌的螺旋CT征象与血清中Cyfra21-1表达的相关性。方法选择76例术前未进行化疗和放疗的食管鳞癌患者,全部患者术前均行螺旋CT增强扫描,分析螺旋CT对食管鳞癌淋巴结转移诊断的灵敏度、特异度、准确率;采用电化学发光法检测食管鳞癌患者术前血清中Cyfra21-1的表达。对食管鳞癌患者术前CT征象与Cyfra21-1检测结果进行比较,分析其相关性。结果 76例食管鳞癌患者中,螺旋CT扫描诊断与手术病理结果对照,对淋巴结转移诊断的灵敏度为67.5%,特异度为83.3%,准确率为75.0%,Kappa值为0.512。螺旋CT表现为肿瘤长度>5cm者Cyfra21-1表达的阳性率高于肿瘤长度≤5cm者(P<0.05);CT表现为食管管壁增厚>1cm者Cyfra21-1表达的阳性率高于管壁增厚≤1cm者(P<0.01);CT表现有淋巴结转移组Cy-fra21-1表达的阳性率高于无淋巴结转移者(P<0.05)。肿瘤位于食管上、中、下段者Cyfra21-1表达的阳性率比较无明显差异(P>0.05)。经病理证实有淋巴结转移者食管癌患者血清中Cyfra21-1阳性表达率高于无淋巴结转移者,差异有统计学意义(P<0.05),Cyfra21-1的阳性表达与食管癌淋巴结转移存在相关性(P<0.05)。结论 Cyfra21-1阳性表达与食管癌CT征象上癌肿长度、管壁增厚程度和淋巴结转移相关,螺旋CT扫描对术前诊断食管癌淋巴结转移有一定的帮助。

Objective To investigate the correlation of spiral CT（SCT）features and the expression of serum Cyfra21-1 in patients with esophageal squamous cell carcinoma.Methods Seventy six cases of patient with esophageal squamous cell carcinoma were reviewed,all of the them were examined with SCT and contrast-enhanced scan before operation.The serum level of Cyfra21-1 were determined in these patients by immunoradiometric assay.Compared with the SCT feature and the expression of Cyfra21-1,the inherent relationship between them was analyzed.Results Compared with operation and pathology,the accuracy of SCT detect lymph node metastasis was 75%,the sensitivity was 67.5%,and the specificity was 83.3%,the Kappa was 0.512.In the group that the length of tumor 5 cm and the group that the length of tummor ≤5 cm in SCT feature,the positive rate of Cyfra21-1 was 45.5%（15/33）and 20.9%（9/43）,there was statistically significant between the two groups.In the group that the thickness of tumor 1cm and the group that the thickness of tummor ≤1 cm in SCT feature,the positive rate of Cyfra21-1 was 43.5%（20/46）and 13.3%（4/30）,there was statistically significant between the two groups.In the group with lymph node metastasis and the group without lymph node metastasis in SCT feature,the positive rate of Cyfra21-1 was 48.5%（16/33）and 18.6%（8/43）,there was statistically significant between the two groups.The positive expression of Cyfra21-1 were not closely related with the tumor position of gross morphology in patients with esophageal squamous cell carcinoma.Compared with pathology,the group with lymph node metastasis and the group without lymph node metastasis,the positive rate of Cyfra21-1 was 42.5%（17/40）and 19.4%（7/36）,and there was statistically significant.The positive expression of Cyfra21-1 were related with lymph node metastasis.Conclusion（1）SCT scan was a valuable diagnostic technique on lymph node metastasis for the patient with esophageal squamous cell carcinoma;（2）The positive expression of Cyfra21-1 was related to the length、the thickness、 and lymph node metastasis of CT feature;（3）The positively expression of Cyfra21-1 was related to the lymph node metastasis of patients with esophageal squamous cell carcinoma.