血清肿瘤标记物NSE、CEA、SCC、ProGRP及CYFRA21-1对肺癌病理类型的鉴别诊断价值

Differential diagnostic value of serum tumor markers NSE,CEA,SCC,ProGRP and CYFRA21-1 in pathological types of lung carcinoma

目的评估血清肿瘤标记物神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、鳞状细胞癌抗原(SCC)、胃泌素释放肽前体(ProGRP)及细胞角蛋白19片段(CYFRA21-1)对小细胞肺癌(SCLC)与非小细胞肺癌(NSCLC)、腺癌与鳞癌的鉴别诊断价值。方法选取于西安交通大学附属二一五医院就诊的患者96例,其中NSCLC 80例(腺癌58例,鳞癌22例),SCLC 16例,使用电化学发光法对所有患者行血清肿瘤标记物检测。统计SCLC与NSCLC、腺癌与鳞癌间各项血清肿瘤标记物是否存在差异,并采用受试者工作曲线(ROC)进行诊断效能评价。结果 ProGRP水平在SCLC与NSCLC两组间差异有统计学意义(P<0.05),SCC在腺癌及鳞癌两组间差异有统计学意义(P<0.05);ProGRP对SCLC与NSCLC鉴别诊断的ROC曲线下面积为0.926,灵敏度为97.7%,特异度为87.5%。SCC对腺癌及鳞癌鉴别诊断的ROC曲线下面积为0.690,灵敏度50.0%,特异度87.9%。结论可考虑将血清肿瘤标记物ProGRP用来鉴别SCLC与NSCLC;将SCC用来鉴别鳞癌与腺癌。

Objective To evaluate the differential diagnostic value of serum tumor markers such as neuronspecific enolase(NSE),carbohydrate antigen(CEA),squamous cell carcinoma associated antigen(SCC),gastrin-releasing peptide(ProGRP)and cytokeratin-19-fragment(CYFRA21-1)in small cell lung carcinoma(SCLC)and non-small cell lung carcinoma(NSCLC),adenocarcinoma and squamous cell carcinoma.Methods 96 patients were selected Affiliated 215 Hospital of Xi′an Jiaotong University including 80 cases of non-small cell lung carcinoma(58 adeno carcinomas,22 squamous cell carcinomas),16 cases of small cell lung carcinoma.Then,Serum tumor markers were detected in all patients preoperatively using electrochemical luminescence.The group differences of serum tumor markers between SCLC and NSCLC,adenocarcinoma and squamous cell carcinoma were calculated by Mann-Whitney U test of independent samples,and evaluation of diagnostic efficacy with the receiver operating characteristic curve(ROC).Results There was significant difference on ProGRP between SCC and NSCLC(P<0.05).There was significant difference in SCC between adenocarcinoma and squamous cell carcinoma(P<0.05).After fitting five tumor markers with binary logistic regression,ProGRP was an independent risk factor for differentiating SCLC from NSCLC,SCC was an independent risk factor for differentiating adenocarcinoma from squamous cell carcinoma.The area under ROC curve of ProGRP in differential diagnosis of SCLC and NSCLC was 0.926,the sensitivity was 97.7%,and the specificity was 87.5%.The area under ROC curve of SCC in differential diagnosis of adenocarcinoma and squamous cell carcinoma was 0.690,the sensitivity was 50.0%,and the specificity was 87.9%.Conclusion Serum tumor marker ProGRP can be used to differentiate SCLC from NSCLC before operation,and SCC can be used to differentiate squamous cell carcinoma from adenocarcinoma with good specificity.