肺癌患者血清肿瘤标志物水平变化与化疗疗效及生存时间的相关性

Changes of tumor markers levels in serum from patients with lung carcinoma and the correlations with efficacy of chemotherapy and survival time

目的探讨晚期肺癌患者化疗前后血清癌胚抗原(CEA)、细胞角质蛋白(CYFRA21-1)、鳞状细胞癌抗原(SCC)和神经烯醇化酶(NSE)水平变化与化疗疗效及生存时间的相关性。方法分别采集2006年1月至2012年6月确诊肺癌(Ⅲb-Ⅳ期)116例患者的化疗前及四疗程化疗后的血清标本,检测每份标本CEA、CYFRA21-1、SCC和NSE四种肿瘤标记物水平,探讨它们之间的差值差异及与化疗效果和生存时间的关系。结果四疗程化疗有效及进展的患者中位生存时间为16个月及9个月;结合生存曲线显示化疗有效的晚期肺癌患者较进展者生存时间更长。化疗前后肿瘤标志物水平变化与化疗疗效密切相关。化疗有效者相应肿瘤标志物下降;进展者标志物上升。其中不同疗效组的鳞癌患者CYFRA21-1及SCC水平,腺癌患者CEA水平,小细胞癌患者CEA及NSE差值差异明显(P<0.05)。通过比较不同生存时间组的患者化疗前后肿瘤标志物的差值差异发现患者生存时间越长,化疗后相应的肿瘤标志物下降幅度越大;生存时间越短标志物上升越明显。其中鳞癌患者CYFRA21-1及SCC,腺癌患者CEA和小细胞癌患者CEA及NSE指标变化有统计学意义。结论 CEA、CYFRA21-1,SCC和NSE这四种肿瘤标志物化疗前后差值可作为反映化疗疗效及评估一年生存时间的重要指标,且具有病理类型的特异性。

Objective To study level differences of carcino embryonic antigen （CEA）, cytokeratin21-1 （CYFRA21-1）, squamous cell carcinoma （SCC） and neuron specific erdase （NSE） before and after chemotherapy in advanced lung carcinoma and the correlations with efficacy of chemotherapy and survival time. Methods To take serum samples in patients diagnosed with advanced lung cancer （ Ⅲ b-Ⅳ ） before and 4 courses after chemotherapy from 2006.1 to 2012.6. Each of the samples were detected with CEA, CYFRA21- 1, SCC and NSE four tumor markers. The differences between them were compared and to explore the relationship with curative effect and survival time. Results The median survival time of patients from chemotherapy effective group and development group respectively： sixteen months and nine months. Combined with survival curve, patients with advanced lung carcinoma in effective group live longer. Tumor marker levels before and after chemotherapy have related to the efficacy of chemotherapy. Tumor index rise after effective chemotherapy and decline corresponding progress. From different groups the levels of CYFRA21-1 and SCC in patients with squamous cell carcinoma, CEA with adenocarcinoma, CEA and NSE with small cell carcinoma had statistically significant differences （ P 〈 0.05 ）. The difference between tumor markers before and after chemotherapy in patients with different survival time were found, The longer the survival time of patients, the lower corresponding index with tumor after chemotherapy; conversely the shorter survival time index with increased more. The obvious differences were in CYFRA21-1 and SCC with squamous cell carcinoma patients, CEA with ad patients and CEA and NSE with small cell carcinoma patients （ P 〈 0. 05 ）Conclusions The index changes of CEA, CYFRA21-1, SCC and NSE can be used as the important indicators for evaluating the effect of chemotherapy and one year survival time with specific pathological types.