血清胃泌素释放肽前体在小细胞肺癌鉴别诊断及疗效监测中的价值

The value of serum ProGRP in differential diagnosis and curative evaluation in small cell lung cancer

目的探讨血清胃泌素释放肽前体(Pro GRP)在小细胞肺癌(SCLC)鉴别诊断、疗效监测中的临床意义。方法收集2015年12月至2017年7月在安徽省立医院西区诊治的334例患者资料,其中SCLC134例,NSCLC和肺良性疾病(BLD)患者各100例。回顾性分析其化疗前血清Pro GRP、神经烯醇化酶(NSE)和癌胚抗原(CEA)的水平及治疗过程中血清Pro GRP水平变化,评估血清Pro GRP在SCLC诊治中临床意义。结果 (1)血清Pro GRP和NSE在SCLC患者组均显著高于NSCLC组和肺良性疾病(BLD)组,P <0. 05。(2)受试者工作特征曲线(ROC)曲线分析cut-off值取185. 25时,血清Pro GRP对SCLC诊断敏感性74. 6%,特异性100%。(3)血清Pro GRP水平与SCLC患者临床特征无相关性。(4)化疗前SCLC治疗有效组和无效组血清Pro GRP水平差异无统计学意义(1 556比1 025 ng·L-1,P>0. 05),治疗有效组血清Pro GRP进行性下降,末次化疗后血清Pro GRP与治疗前差异有统计学意义(121. 8 ng·L-1,P <0. 05)。治疗无效组血清Pro GRP水平在化疗2周期后下降,随后上升。末次化疗后血清Pro GRP水平与化疗前差异无统计学意义(989. 7 ng·L-1,P>0. 05)。结论血清Pro GRP水平对SCLC鉴别诊断具有高度特异性,SCLC患者治疗过程中Pro GRP水平与治疗疗效呈负相关,对SCLC鉴别诊断和疗效预测的具有一定临床意义。

Objective To explore the differential diagnostic and curative evaluation value of gastrin-releasing peptide pecurson(ProGRP)in small cell lung cancer(SCLC).Methods Patients with SCLC who received the first line chemotherapy in Anhui Provincial Cancer Hospital from December 2015 to July 2017 were enrolled and retrospectively analyzed.Clinical characteristic(includes ProGRP,NSE and CEA level before chemotherapy and ProGRP level in chemotherapy courses)and efficacy evaluation were analyzed.Results (1)The ProGRP and NSE of serum could distinguish SCLC from non-small-cell lung cancer.(2)The diagnostic sensitivity and specificity of serum ProGRP to SCLC was 74.6%and 100%,respectively,when cut-off was 185.25.(3)All clinical characteristics that had been analyzed showed no statistical significance in terms of prognosis.(4)Before treatment,the level of ProGRP had no statistical significance between effective groups(CR+PR)and ineffective groups(SD+PD).ProGRP level decreased obviously with the chemotherapy in effective groups,which was significantly lower after the last chemotherapy than before treatment.In ineffective groups,ProGRP level declined in the 2 cycles of chemotherapy and then increased.The level of ProGRP were not statistical significant before and after chemotherapy.Conclusions The ProGRP assay is specific for diagnosing SCLC.Changes in ProGRP during chemotherapy are significantly associated with image-based response.