全身骨显像联合肿瘤标志物检测对乳腺癌骨转移诊断、病情评价及放疗疗效评估的临床意义

Clinical significance of whole-body bone scintigraphy combined with tumor markers detection in the diagnosis,the disease evaluation and the therapeutic effect assessment of radiotherapy for patients with breast cancer complicated with bone metastasis

目的观察和分析单光子发射型计算机辅助断层（SPECT）全身骨显像联合肿瘤标志物检测对乳腺癌骨转移诊断、病情评价及放疗疗效评估的临床意义。方法选取200例乳腺癌患者作为研究对象,于术后给予患者SPECT全身骨显像检查和血清糖链抗原15-3（CA15-3）、癌胚抗原（CEA）及碱性磷酸酶（ALP）等肿瘤标志物检测。对发生骨转移的患者给予放疗治疗,并于治疗后复查SPECT全身骨显像和血清肿瘤标志物水平。结果 3种肿瘤标志物联合检测在诊断乳腺癌骨转移中的灵敏度显著高于单独检测（χ^2=8.067、12.079、10.376,P〈0.05）,全身骨显像的灵敏度显著高于单独检测或联合检测3种肿瘤标志物（χ^2=28.058、34.842、32.041、6.512,P〈0.05）,3种肿瘤标志物与全身骨显像联合检测的灵敏度显著高于单独检测或联合检测3种肿瘤标志物及单独检测全身骨显像（χ^2=74.169、83.557、79.732、38.922、16.316,P〈0.05）。随着乳腺癌骨转移分级的升高,其血清肿瘤标志物水平均呈显著上升的趋势（P〈0.05）,并与患者的骨转移分级具有相关性（r_s=0.859、0.602、0.661,P〈0.05）;治疗有效组患者治疗后的血清肿瘤标志物水平均较治疗前显著降低（t=25.615、15.633、42.816,P〈0.05）,且均显著低于治疗无效组（t=9.972、12.454、8.297,P〈0.05）。结论联合应用全身骨显像检查和肿瘤标志物检测可提高对于乳腺癌骨转移的诊断灵敏度,肿瘤标志物水平可作为评价骨转移程度和放疗疗效的辅助指标。

Objective To observe and analyze the clinical significance of whole-body bone scintigraphy by single-photon emission computed tomography（ SPECT） combined with tumor markers detection in the diagnosis,the disease evaluation and the therapeutic effect assessment of radiotherapy in patients with breast cancer complicated with bone metastasis. Methods A total of 200 patients with breast cancer were selected. The whole-body bone scintigraphy by SPECT and the serum tumor markers of carbohydrate antigen 15-3（ CA15-3）,cancer embryo antigen（ CEA） and alkaline phosphatase（ ALP） after surgery were detected. The patients complicated with bone metastasis were treated with radiotherapy,and the whole-body bone scintigraphy by SPECT and the serum tumor markers were reviewed. Results The sensitivity of the combined detection of the three tumor markers in the diagnosis of breast cancer complicated with bone metastases was significantly higher than that of single detection（ χ~2= 8. 067,12. 079,10. 376,P〈0. 05）,the sensitivity of whole-body bone scintigraphy by SPECT was significantly higher than that of combined detection or single detection of the three tumor markers（ χ~2= 28. 058,34. 842,32. 041,6. 512,P〈0. 05）,and the sensitivity of combined detection of whole- body bone scintigraphy by SPECT and detection of three tumor markers was significantly higher than that of combined detection of the three tumor markers and the single detection of the three tumor markers or whole-body bone scintigraphy by SPECT（ χ~2= 74. 169,83. 557,79. 732,38. 922,16. 316,P〈0. 05）. With the increasing grade of bone metastasis of breast cancer,the serum levels of tumor markers significantly increased（ P〈0. 05）,and were correlated with the grade of bone metastasis of the patients（ r_s= 0. 859,0. 602,0. 661,P〈0. 05）. The serum tumor marker levels of the patients in the effective treatment group after the treatment decreased significantly when compared with those before the treatment（ t = 25. 615,15. 633,42. 816,P〈0. 05）,and were significantly lower than those in the ineffective treatment group（ t = 9. 972,12. 454,8. 297,P〈0. 05）. Conclusion Combined detection of whole-body bone scintigraphy and tumor marker can improve the diagnostic sensitivity of breast cancer complicated with bone metastasis. The tumor markers can be used as the auxiliary indexes to evaluate the degree of bone metastasis and the efficacy of radiotherapy.