乳腺癌患者新辅助化疗前后血清细胞角蛋白19片段抗原21-1、糖类抗原125水平变化与疗效的关系

Changes of serum CYFRA21-1 and CA125 levels before and after neoadjuvant chemotherapy in breast cancer patients and their relationship with efficacy

目的探讨乳腺癌患者新辅助化疗前后血清细胞角蛋白19片段抗原21-1(CYFRA21-1)、糖类抗原125(CA125)水平变化与疗效的关系。方法采用随机数字表法选取2015年3月至2018年 3月青海省第五人民医院乳腺癌患者80例进行回顾性研究。所有患者均给予多西他赛+多柔比星+环磷酰胺(TAC)方案化疗,采用酶联免疫吸附法检测血清CYFRA21-1、CA125水平,分析CYFRA21-1、CA125与新辅助化疗疗效的关系。血清CYFRA21-1、CA125水平的组间比较采用独立样本 t 检验,同组治疗前后比较采用配对 t 检验,采用受试者工作特征(ROC)曲线分析不同指标(CYFRA21-1、CA125、CYFRA21-1联合CA125)评估乳腺癌化疗疗效的效能。结果乳腺癌患者化疗后血清CYFRA21-1、CA125水平均明显低于化疗前[(4.51±0.53) ng/ml 比(4.95±0.65) ng/ml , t =4.692, P <0.001;(250.34±28.63) U/ml 比(275.42±30.52) U/ml, t =5.361, P <0.001]。乳腺癌患者化疗有效者36例(完全缓解8 例+部分缓解28例),无效者44例(病情稳定26例+病情进展18例),化疗有效率为45.0%(36/80)。化疗有效者化疗后血清CYFRA21-1、CA125水平均明显低于化疗前[(3.22±0.47)ng/ml 比( 4.94± 0.53) ng/ml, t =14.568, P <0.001;(180.34±22.42)U/ml比(274.21±30.82)U/ml, t =14.778, P <0.001)],化疗无效者化疗后血清CYFRA21-1、CA125水平均明显高于化疗前[(6.21±0.84) ng/ml比(4.97±0.55)ng/ml ,t =8.192, P <0.001;(310.26±37.34)U/ml比(276.12±30.92)U/ml, t = 4.671, P <0.001)]。ROC曲线分析结果显示,CYFRA21-1下降比以>10%为临界值,CYFRA21-1在评估乳腺癌新辅助化疗疗效的敏感度、特异度、准确率、曲线下面积分别为77.78%(28/36)、81.82%( 36/44 )、80.00%(64/80)、0.762;CA125下降比以>12%为临界值,CA125在评估乳腺癌新辅助化疗疗效的敏感度、特异度、准确率、曲线下面积分别为72.22%(26/36)、77.27%(34/44)、75.00%(60/80)、0.758;两个指标联合评估时,敏感度、特异度、准确率、曲线下面积分别为94.44%(34/36)、95.45%(42/44)、95.00%(76/80)、0.906。两者联合时的准确度、曲线下面积明显高于两者单独使用时( P 均<0.017)。结论乳腺癌患者新辅助化疗前后血清CYFRA21-1、CA125水平变化与疗效有关,CYFRA21-1、 CA125可作为评估新辅助化疗疗效的指标,且两者联合时具有更佳的预测效能。

Objective To explore the change of serum cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) and carbohydrate antigen 125 (CA125) levels before and after neoadjuvant chemotherapy in patients with breast cancer and their relationship with the efficacy. Methods Totally 80 breast cancer patients in the Fifth People’s Hospital of Qinghai Province from March 2015 to March 2018 were enrolled for a retrospective study. All patients were treated with neoadjuvant chemotherapy of docetaxel+ adriamycin+ cyclophosphamide (TAC) regimen. The serum CYFRA21-1 and CA125 levels were detected by the enzyme- linked immunosorbent assay. The relationship between serum CYFRA21-1 and CA125 levels and the efficacy of neoadjuvant chemotherapy was analyzed. The independent sample t test was used for comparison between groups. The paired t test was used for the comparison before and after treatment in the same group. The receiver operating characteristic(ROC) curve was used to analyze the predictive value of different methods (CYFRA21-1, CA125, CYFRA21-1 combined with CA125) in evaluating the efficacy of chemotherapy. Results The serum levels of CYFRA21-1 and CA125 in patients with breast cancer after chemotherapy were significantly lower than those before chemotherapy [(4.51±0.53) ng/ml vs (4.95±0.65) ng/ml, t =4.692, P <0.001;(250.34±28.63) U/ml vs (275.42±30.52) U/ml, t =5.361, P <0.001]. The chemotherapy proved effective in 36 patients (8 with complete remission and 28 with partial remission), ineffective in 44 patients (26 with stable disease and 18 with disease progression), and the effective rate of chemotherapy was 45.0%(36/80). In effective chemotherapy group, serum levels of CYFRA21-1 and CA125 after chemotherapy were significantly lower than those before chemotherapy [(3.22±0.47) ng/ml vs (4.94± 0.53) ng/ml, t =14.568, P <0.001;(180.34±22.42)U /ml vs (274.21±30.82) U/ml, t =14.778, P <0.001]. In ineffective chemotherapy group, serum levels of CYFRA21-1 and CA125 after chemotherapy were significantly higher than those before chemotherapy [(6.21±0.84) ng/ml vs (4.97±0.55) ng/ml, t =8.192, P <0.001;(310.26±37.34) U/ml vs (276.12±30.92) U/ml, t =4.671, P <0.001]. ROC curve analysis showed that in assessing the efficacy of neoadjuvant chemotherapy in breast cancer patients, the sensitivity, specificity, accuracy, and area under the curve was 77.78%(28/36),81.82%(36/44),80.00%(64/80)and 0.762 for CYFRA21-1 (critical value: the reduction ratio >10%), 72.22%(26/36), 77.27%(34/44), 75.00%(60/80)and 0.758 for CA125 (critical value: the reduction ratio >12%), 94.44%(34/36), 95.45%(42/44), 95.00%(76/80) and 0.906 for the combination of both factors. The accuracy and area under the curve in combination of both were significantly higher than those when either factor was used (all P <0.017). Conclusion The changes of serum CYFRA21-1 and CA125 levels in breast cancer patients before and after neoadjuvant chemotherapy are related to the efficacy of neoadjuvant chemotherapy, so CYFRA21-1 and CA125 can be used as indicators for efficacy evaluation, and the combination of both may have a better predictive value.