血清细胞角蛋白19片段与胸腺肿瘤临床病理特征和预后的相关性研究

Correlation between Serum Cytokeratin 19 Fragment and the Clinicopathological Features and Prognosis of Thymic Epithelial Tumors

背景与目的胸腺肿瘤中尚无肿瘤标志物的应用,本研究旨在评估血清细胞角蛋白19片段(cytokeratin 19 fragment,Cyfra 21-1)与胸腺肿瘤临床病理特征和预后的相关性。方法回顾性分析上海市胸科医院2012年11月-2016年9月收治的159例胸腺肿瘤病例的临床资料。比较术前血清Cyfra 21-1水平在不同分期及组织学类型间的差异,研究术前及术后血清Cyfra 21-1水平与复发的关系。结果在局部晚期(T4期)(P<0.001)、胸腺癌(P<0.001)患者中,术前血清Cyfra 21-1水平显著升高,且当术前Cyfra 21-1≥1.66 ng/m L时,其对术后复发有提示意义。分析患者随访的血清Cyfra 21-1,将2.66 ng/m L作为cut-off值时,提示胸腺肿瘤复发的敏感度为0.667,特异度为0.925,阳性预测值为0.462,阴性预测值为0.966。结论术前患者血清Cyfra 21-1水平较高,有助于提示肿瘤分期较晚、肿瘤恶性程度较高,或可提示术后复发的风险升高。在随访时结合血清Cyfra 21-1检测,将可能有助于提高复发患者的检出率,改善预后。

Background and objective So far there＇s no tumor maker applied in diagnosis and treatment ofthymic epithelial tumors. This study is to assess the correlation between serum cytokine 19 fragment （Cyfra 21-1） and clinicopath-ological features and prognosis of thymic epithelial tumors （TETs）. Methods The clinical data of 159 patients with TETs in Shanghai Chest Hospital was retrospectively analysed. Patients were divided into groups according to different tumor stages and histotypes. Serum Cyfra 21-1 was thus compared. In addition, the possible relationship between perioperative serum Cyfra 21-1 level and the recurrent status was carrid out. Results Preoperative Cyfra 21-1 serum concentrations in patiants with advanced stage （T4） and thymic carcinomas were significantly higher than that in others （P〈0.001, P〈0.001, respectively）. When the preoperative serum level exceeds the out-off of 1.66 ng/mL, it possibly indicates the recurrence during follow up. Furthermore, the sensitivity, specificity, and positive as well as negative predictive value （PPV and NPV） of postoperative Cyfra 21-1 to predict tumor recurrence were evaluated. At a cut-off of Cyfra 21-1 of 2.66 ng/mL, the sensitivity was 0.7, the specificity was 0.925, the PPV was 0.5 and the NPV was 0.966. Conclusion The elevated level of preoperative serum Cyfra 21-1 indicates an advanced stage of tumor or a more malignant histotype （thymic carcinoma）. It also probably suggests a higher risk of tumor recurrence. During the oncological follow up, in addition to regular imaging examinations, the blood test of serum Cyfra 21-1 is also suggested to improve the diagnosis of tumor recurrence in order to improve the prognosis.