肺癌血清标志物在健康体检中的价值分析

Analysis of serum biomarkers for lung cancer in the health examination

目的研究鳞状细胞癌相关抗原(SCC)、神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)及细胞角蛋白19片段(Cyfra21-1)4种肿瘤标志物筛查肺癌的价值及成本,探讨适合健康人群肺癌筛查的方法。方法回顾性分析进行健康体检的25 744位体检者的资料。统计不同项目联合检查方案对肺癌的检出率和早期检出率(简称早检率),对比同期门诊肺癌检出率,选择合适的筛查组合。计算发现肺癌和早期肺癌的费用及不同年龄段的肺癌检出费用。对比全国人均国内生产总值(GDP)和黑龙江人均GDP,通过计算早期诊断花费系数(EDCI)探讨筛查方法的价值。结果 "SCC+NSE+CEA+Cyfra21-1"联合筛查肺癌检出率为119/10万,早检率为77.4%,明显高于同期门诊肺癌的早检率(21.17%),差异有统计学意义(χ2=48.095,P﹤0.01)。每例肺癌的发现成本为224 761元,每例早期肺癌的发现成本为290 316元。以全国人均GDP计算EDCI为6.40,以黑龙江省人均GDP计算EDCI为7.64。以黑龙江人均GDP计算,55岁及以下体检者EDCI(21.13)是55岁以上者(4.08)的5.18倍。以全国人均GDP计算,55岁以上体检者EDCI仅为3.42。结论 "SCC+NSE+CEA+Cyfra21-1"联合筛查肺癌检出率和早检率较高,成本尚可接受,通过选择高危人群,可以进一步提高筛查效率,降低筛查成本。

Objective To investigate the value and cost of 4 serum biomarkers,including squamous cell carcinoma（SCC）,neuron-specific enolase（NSE）,carcinoembryonic antigen（CEA） and cytokeratin 19 fragment（Cyfra21-1）,for lung cancer screening in healthy populations.Method 25 744 normal subjects who were administered with health examination were retrospectively analyzed,the detection rate and early detection rate of lung cancer by different combinations of the 4 biomarkers were statistically recorded and compared,and the appropriate combination for lung cancer screening was determined.We counted the cost of lung cancer detection and early lung cancer detection,according to Price of Nonprofit Medical Service of Heilongjiang Province,by comparing with means gross domestic product（GDP） and GDP per person in Heilongjiang province,and then the early detection cost index（EDCI） was calculated to assess the value of each screening method.Result The combination of＂SCC ＋ NSE ＋ CEA ＋ Cyfra21-1＂had the highest detection efficiency at119/100 000,with an early detection rate of 77.4%,which was significantly higher than that in outpatients during the same period at 21.17%,with significant difference observed（χ2=48.095,P〈0.01）.The average cost of diagnosing 1 case of lung cancer patient was RMB 224 761 and was RMB 290 316 for an early-stage lung cancer case.The EDCI was 6.40 based on national GDP and was 7.64 based on Heilongjiang GDP.In Heilongjiang province,the EDCI of health examination for those who under 55 years of ages（21.13） was 5.18 times more than that of those over 55 years of age（4.08）.Based on national GDP,the EDCI was only 3.42 for health examination in the population over 55 years old.Conclusion The detection rate and early diagnose rate of the tumor markers combination of SCC＋NSE＋CEA＋Cyfra21-1 is relatively high,with acceptable cost,and it＇s feasible to improve screening efficiency and reduce costs by screening high-risk group.