血清癌胚抗原 细胞角蛋白19片断21-1和神经元特异性烯醇化酶联合检测对肺腺癌 鳞癌化疗预后的价值研究

Combined detection of serum carcinoembryonic carcinogen,cytokeratin fragment 21-1 and neuron-specific enolase for prediction of the prognosis of pulmonary adenocarcinoma and squamous cell carcinoma after chemotherapy:analysis of clinical significance

目的探讨癌胚抗原(CEA)、细胞角蛋白19片断21-1(CYFRA21-1)及神经元特异性烯醇化酶(NSE)检测在化疗后肺腺癌、鳞癌患者预后判断中的临床意义。方法收集2007-01-01—2009-12-31中国医科大学附属第四医院189例确诊后接受一线化疗的肺腺、鳞癌患者,计算2个周期化疗前后3种肿瘤标志物(CEA、CYFRA21-1及NSE)的下降率,观察生存期。结果化疗后肺腺、鳞癌患者CEA、CYFRA21-1、NSE的变化趋势与预后相关,肿瘤标志物较前下降的患者与较前上升的患者相比,生存期明显延长。化疗后CEA下降率预测预后的最佳截断点为63.9%,30.1%,46.8%。联合检测肿瘤标志物的下降率对预后的预测能力较单一检测明显增强,差异均有统计学意义(P<0.001)。结论肺腺、鳞癌患者化疗后CEA、CYFRA21-1和NSE的下降率与患者生存期相关,CEA、CY-FRA21-1和NSE可预测化疗后患者的预后,血清CEA、CYFRA21-1和NSE在化疗期间下降明显者提示预后较好,生存期较长,联合检测较单一检测对预后的提示能力更佳。

Objective To investigate the clinical significance of combined detection of serum carcinoembryonic carcinogen （CEA） ,cytokeratin fragment 21-1 （CYFRA21-1） and neuron-specific enolase （NSE） for the prognosis of pulmonary adenocarcinoma and squamous cell carcinoma after chemotherapy. Methods We enrolled 189 patients with confirmed diagnosis of pulmonary adenocarcinoma and squamous cell carcinoma who received first-line chemotherapy in the Fourth Affiliated Hospital of China Medical University between January 1 st,2007 and December 31st,2009. The decline in the level of three tumor markers （CEA, CYFRA21-1 and NSE） was determined after chemotherapy for 2 cycles. AIso calculated was the sur- vival duration. Results The trends of variation in CEA, CYFRA21-1 and NSE were correlated with the prognosis of patients with pulmonary adenocarcinoma and squamous cell carcinoma after chemotherapy. Those with declined, but not elevated lev- el of tumor markers were associated considerably prolonged survival. The optimal cut point for prognosis prediction was 63.9% ,30. 1% and 46. 8% for the decline in CEA, CYFRA21-1 and NSE ,respectively. Combined detection was found to have higher capacity for predicting prognosis （P 〈 0. 001 ）. Conclusion The decline in CEA, CYFRA21-1 and NSE is as- sociated with survival of patients with pulmonary adenocarcinoma and squamous cell carcinoma after chemotherapy. CEA, CYFRA21-1 and NSE may be the predictors of the prognosis after chemotherapy. Marked reduction in serum CEA, CYFRA21-1 and NSE during chemotherapy is an indicator of superior prognosis and longer survival. Combined detection confers superiority for predicting the prognosis as compared with single parameter.