应用ROC曲线评价CEA、CYFRA21-1、SCC对非小细胞肺癌的诊断价值

Application of ROC curve to evaluate CEA,CYFRA21-1,SCC to non-small cell lung cancer diagnosis value

目的探讨癌胚抗原(CEA)、细胞角蛋白19片段抗原(CYFRA21-1)、鳞癌相关抗原(SCC)对非小细胞肺癌(NSCLC)的诊断价值并找出此3种肿瘤标志物(TM)对NSCLC的临床诊断界值(cut off值)。方法对99例NSCLC患者、50例肺部良性疾病患者以及50例健康体检者血清中CEA、CYFRA21-1、SCC水平进行检测。CEA、CYFRA21-1采用电化学发光免疫分析法测定,SCC采用化学发光微粒子免疫分析法测定。利用ROC曲线对此3项TM的检测结果进行分析,评价其对NSCLC的诊断价值并找出其cut off值。结果 (1)NSCLC组中CEA、CYFRA21-1水平与良性疾病组及健康组比较差异均有统计学意义(P<0.05)。腺癌组CEA水平显著高于鳞癌组、良性疾病组和健康组(P<0.05)。腺癌组和鳞癌组CYFRA21-1水平均显著高于良性疾病组和健康组(P<0.05),而腺癌组CYFRA21-1水平与鳞癌组比较差异无统计学意义(P>0.05)。鳞癌组SCC水平与腺癌组、良性疾病组和健康组比较差异均有统计学意义(P<0.05)。此3项TM水平在良性疾病组与健康组中差异无统计学意义(P>0.05)。(2)CEA、CYFRA21-1对NSCLC诊断均有较好的准确性,其曲线下面积(AUC)分别为0.74±0.042、0.72±0.042,cut off值特异性均达到82%。CEA对腺癌的诊断有较高的特异性;CYFRA21-1对鳞癌的诊断有较高的特异性;鳞癌组SCC的特异性虽然较高,但敏感性却较低。(3)CEA、CYFRA21-1和SCC在NSCLC中的cut off值分别为3.35、2.98、1.05ng/mL。结论 CEA、CYFRA21-1对NSCLC有较好的诊断价值。CEA是诊断腺癌最有价值的指标,CYFRA21-1对鳞癌的诊断具有较高的价值,而SCC对NSCLC的诊断价值有限,仅对鳞癌的诊断具有一定作用。

Objective To investigate the diagnosis value of CEA,CYFRA21-1 and SCC in non-small cell lung cance（NSCLC）,and discover the clinical cut off point of them.Methods Serum concentration of CEA,CYFRA2l-1 and SCC was measured in 99 patients with NSCLC,50 patients with benign lung disease and 50 healthy subjects.CEA and CYFRA21-1 were measured by electrochemiluminescence immunoassays on the Roche Eleesys170,and SCC was measured by ehemiluminesent micmparticle Immmmassay on ARCHITECT i2000SR.Used ROC curve to analysis the three tests results for TM to evaluate the diagnostic value of NSCLC and discovered their cutoff point.Results（1）CEA and CYFRA21-1 in NSCLC were significantly higher than those in controls（P0.05）.Besides,CEA was highest in lung adenocarcinoma（AD,P0.05）,while CYFRA21-1 was paralleled in AD and squamous cell lung cancer（SQC,P0.05）.SCC in SQC was significantly higher that in than controls and AD（P0.05）.Moreover,there was no significant difference between the benign pulmonary diseases group and the healthy one（P0.05）.（2）The AUC of CEA and CYFRA21-1 were respectively 0.74±0.042 and 0.72±0.042,in cutoff point their specificity were 82%.Interestingly,The AUC of CEA in AD was 0.81±0.043 with the specificity of 86%.The AUC of CYFRA21-1 in SQC was 0.77±0.051 with the specificity of 90%.Notablely,although the specificity of SCC in SQC was 80%,its sensitivity was 43.2%.（3）The cut-off point of CEA、CYFRA21-1 and SCCC were 3.35 ng/mL,2.98 ng/mL and 1.05 ng/mL.Conclusion CEA,CYFRA21-1 have the good diagnosis value to NSCLC.CEA is the most effective tumor markers of AD,while CYFRA21-1 is more effective in SQC.Unfortunately,SCC is less reliable in NSCLC.