非小细胞肺癌肿瘤标志物联合检测在诊断中的意义及其对EGFR突变的预测价值

The Significance of Combined Detection of Tumor Markers in NSCLC Diagnosis and Its Predictive Value on EGFR Mutations

目的探讨血清癌胚抗原、细胞角蛋白19片段与非小细胞肺癌(NSCLC)患者表皮生长因子受体(EGFR)突变状态之间的关系。方法选择2017年2月-2018年3月我院收治的接受EGFR突变检测的148例NSCLC患者为研究对象。手术前测定患者血清细胞角蛋白19片段(CYFRA 21-1)、癌胚抗原(CEA)、鳞状细胞癌相关抗原(SCCA)、神经元特异烯醇化酶(NSE)水平,分析血清肿瘤标志物水平与EGFR突变的相关性。结果148例NSCLC患者中,56例(37.84%)发生EGFR突变。与EGFR野生型患者相比,EGFR突变型患者的血清CEA和CYFRA 21-1水平均显著升高(P<0.05)。CEA和CYFRA 21-1的ROC曲线下面积分别为0.769(95%CI:0.598~0.850,P<0.05)和0.724(95%CI:0.523~0.800,P<0.05)。Logistic回归分析显示,CEA水平(OR=0.519,95%CI:0.277~0.981,P=0.026)和CYFRA 21-1水平(OR=0.739,95%CI:0.375~1.442,P=0.045)是预测EGFR基因突变的独立因素。结论对于NSCLC患者,CEA和CYFRA 21-1水平可用于预测EGFR基因突变。

Objective To investigate the correlations between tumor markers and epidermal growth factor receptor(EGFR)mutation status in non-small cell lung cancer(NSCLC).Methods A total of 148 NSCLC patients who got EGFR mutation analysis and treatment in our hospital between February 2017 and March 2018 were enrolled in this study.The levels of serum tumor markers cytokeratin 19 fragments(CYFRA 21-1),carcino-embryonic antigen(CEA),squamous cell carcinoma antigen(SCCA)and neuron-specific enolase(NSE)were measured before operation.Correlations between the serum levels of tumor markers and EGFR mutations were analyzed.Results Among 148 NSCLC patients,56(37.84%)had EGFR mutation.Compared with wild-type EGFR patients,the serum levels of CEA and CYFRA 21-1 increased significantly in EGFR-mutant patients(P<0.05).ROC analysis showed that the area under the curve of CEA and CYFRA 21-1 was 0.769(95%CI:0.598~0.850,P<0.05)and 0.724(95%CI:0.523~0.800,P<0.05),respectively.Logistic regression analysis showed that CEA level(OR=0.519,95%CI:0.277~0.981,P=0.026)and CYFRA 21-1 level(OR=0.739,95%CI:0.375~1.442,P=0.045)were independent predictors of EGFR gene mutation.Conclusion For NSCLC patients,the preoperative detection of CEA and CYFRA 21-1 level can be utilized to predict EGFR gene mutation.