血清鳞状细胞癌抗原和癌胚抗原联合检测对子宫颈癌的诊断及疗效评价

Combination detection of serum squamous cell carcinoma antigen and carcino-embryonic antigen for the diagnosis of cervical carcinoma and evaluation of effect

目的 探讨鳞状细胞癌抗原（SCC-Ag）和癌胚抗原（CEA）联合检测对子宫颈癌的诊断、疗效评估、病情监测及预后分析的意义.方法 收集经病理确诊的子宫颈癌患者424例,妇科良性病患者400例,酶联免疫吸附法检测SCC-Ag和CEA水平,同时收集子宫颈癌患者的盆腔彩色超声检查结果并进行分析.结果 子宫颈癌组血清SCC-Ag、CEA及二者联合检测的阳性率[55.9 ％（237 /424）、26.4％（112/424）、61.8％（262/424）]均高于良性病组[12.0％（48/400）、12.5％（50/400）、14.5％（58/400）]（均P＜ 0.05）.SCC-Ag和CEA联合检测对子宫颈癌诊断的灵敏度（61.8％）高于CEA、SCC-Ag单项检测（55.9％、26.4％）（均P＜ 0.05）.治疗前血清SCC-Ag、CEA水平在不同的临床分期、病理分型、浸润深度及淋巴结是否转移的子宫颈癌患者间的差异均有统计学意义（均P＜ 0.05）.Ⅰ、Ⅱ期子宫颈癌患者SCC-Ag与CEA联合检测的阳性率[45.5％（71/156）、73.2％（139/190）]高于超声检查[33.3％（52/156）、51.1％（97/150）]（P＜ 0.05）.手术、同步放化疗和手术联合放化疗治疗后SCC-Ag水平（中位数为0.34、0.51、0.33 ng/ ml）低于治疗前（0.48、3.44、1.29 ng/ml）,CEA治疗后水平（中位数为0.75、0.81、0.71 ng/ ml）低于治疗前（1.22、1.53、1.50 ng/ ml）（P＜ 0.05）.三种方式治疗后,SCC-Ag、CEA水平升高及未降至正常范围的子宫颈癌患者中分别有33.3 ％（6/18）、56.5％（13/23）和46.1％（35/76）复发或转移.SCC-Ag阳性患者的生存率低于阴性患者（P＜0.05）,而CEA阳性和阴性患者的生存率差异无统计学意义（P＞0.05）.结论 SCC-Ag和CEA联合检测可作为子宫颈癌辅助诊断的首选标志物.SCC-Ag和CEA联合检测可以作为临床分期、病理分型、浸润深度、淋巴结转移及疗效评价、预后判断的重要指标.对于Ⅰ、Ⅱ期子宫颈癌患者SCC-Ag和CEA联合检测的阳性率高于盆腔超声检查.

Objective To explore the clinical significance of combination detection of serum squamous cell carcinoma antigen （SCC-Ag） and carcino-embryonic antigen （CEA） for the diagnosis,effect evaluation,monitoring and prognosis in cervical carcinoma.Methods Four hundred and twenty-four cases of cervical carcinoma patients diagnosed by pathology and 400 binign gynaecology patients were selected to detect levels of SCC-Ag and CEA by ELISA.Besides,the pelvic color ultrasound results of cervical carcinoma patients were collected and analyzed.Results The positive rates of serum SCC-Ag,CEA and combined detection of cervical carcinoma patients were 55.9 %（237/424）,26.4 %（112/424）,61.8 %（262/424）,which were higher than those of binign gynaecology patients [12.0 %（48/400）,12.5 %（50/400）,14.5 %（58/400）],and the differences were statistical significance （all P〈 0.05）.The sensitivity of combined detection of SCC-Ag and CEA for diagnosing cervical carcinoma （61.8 %） was better than that of detection of alone SCC-Ag or CEA （55.9 %,26.4 %）,and the difference was statistical significance （P 〈 0.05）.The differences of pretreatment serum SCC-Ag and CEA levels in the cervical carcinoma patients who were dependent on clinical stage,pathological type,depth of invasion,lymph node metastasis were statistically significant （all P 〈 0.05）.The combined detection of SCC-Ag and CEA in patients with stage Ⅰ and Ⅱ had higher positive rates [45.5 % （71/156）,73.2 %（139/190）] than those of the ultrasound examination [33.3 %（52/156）,51.1%（97/150）] （P〈 0.05）.After surgery or concurrent chemoradiotherapy or surgery combined radiation and chemotherapy,SCCAg levels of patients in post-treatment （median 0.34,0.51,0.33 ng/ml） were much lower than those of pretreatment （median 0.48,3.44,1.29 ng/ml）,and CEA levels of post-treatment （median 0.75,0.81,0.71 ng/ml）were also lower than those of pre-treatment （median 1.22,1.53,1.50 ng/ml） （P 〈 0.05）.After treatment,cervical cancer patients with the raised or not decreased to the normal range levels of SCC-Ag and CEA had recurrences or metastasis rates of 33.3 %（6/18）,56.5 %（13/23） and 46.1%（35/76）.Survival rate of the patients with positive SCC-Ag was significantly lower than that of patients with negative （P 〈 0.05）,while the survival rate of patients with positive or negative CEA had no difference （P 〉 0.05）.Conclusions Combined detection of SCC-Ag and CEA can be used as an important indicator to estimate clinical stage,pathological type,depth of invasion,lymph node metastasis,curative effect and prognosis of cervical carcinoma.Combined detection of SCC-Ag and CEA had higher positive rates than pelvic color ultrasound examination for cervical carcinoma patients in stage Ⅰ and Ⅱ.