血清癌胚抗原预测可手术甲状腺髓样癌淋巴结转移的临床价值

Clinical significance of serum carcinoembryonic antigen in predicting lymph node metastasis for resectable medullary thyroid carcinoma

目的探讨血清癌胚抗原(carcinoembryonic antigen,CEA)在预测可手术甲状腺髓样癌(medullary thyroid carcinoma,MTC)淋巴结转移中的临床应用价值。方法选取2009年1月至2019年2月在中国科学院大学附属肿瘤医院(浙江省肿瘤医院)头颈肿瘤外科和杭州市第一人民医院肿瘤外科接受手术的140例MTC,回顾性分析血清CEA和140例可手术MTC淋巴结转移的相关性,计算血清CEA预测可手术MTC总体、中央区、侧颈和上纵隔淋巴结转移的受试者工作特征曲线下面积(area under the curve,AUC)、敏感性、特异性,以评估血清CEA表达水平预测可手术MTC淋巴结转移的临床价值。结果140例可手术MTC中有108例血清CEA呈阳性表达,阳性率77.14%。伴淋巴结转移的MTC患者血清CEA显著高于无淋巴结转移者(P<0.001),且血清CEA与淋巴结转移数目正相关(P<0.001)。血清CEA预测可手术MTC总体、中央区、侧颈和上纵隔淋巴结转移的AUC分别为0.773、0.768、0.827及0.847。以约登指数最大时,分别取界值为6.58、11.43、15.74、30.45 ng/ml,血清CEA预测总体、中央区、侧颈和上纵隔淋巴结转移的敏感性分别为88.46%、81.43%、85.00%、95.00%,特异性分别为56.45%、60.00%、71.25%、69.17%。结论血清CEA在可手术MTC中有较高的阳性率,其表达水平在评估MTC淋巴结转移方面具有重要的临床价值。

Objective To investigate the clinical application value of serum carcinoembryonic antigen(CEA)level in predicting lymph node metastasis of resectable medullary thyroid carcinoma(MTC).Methods 140 patients of resectable MTC from Zhejiang Cancer Hospital and Hangzhou First People’s Hospital from Jan.2009 to Feb.2019 were included.The relationship of serum CEA and lymphatic metastasis was retrospectively analyzed in 140 patients of resectable MTC,and the clinical significance of serum CEA for predicting total lymph node,central lymph node,lateral lymph node and upper mediastinal lymph node metastasis was also evaluated.Results The positive rate of serum CEA in resectable MTC was 77.14%.The expression level of serum CEA in resectable MTC with lymph node metastasis was significantly higher than those without lymph node metastasis(P<0.001).Spearman correlation analysis further indicated that the level of serum CEA expression was positively correlated with the number of lymph node metastases of resectable MTC patients(P<0.001).The area under curve of predicting lymphatic metastasis of total lymph node,central lymph node,lateral lymph node and upper mediastinum was 0.773,0.768,0.827 and 0.847.When the cut-off value of serum CEA was 6.58,11.43,15.74 and 30.45 ng/ml,respectively,the sensitivity of serum CEA to predict total,central,lateral neck and upper mediastinal lymph node metastasis was 88.46%,81.43%,85.00%,95.00%,and the specificity was 56.45%,60.00%,71.25%,and 69.17%,respectively.Conclusion Serum CEA has a high positive expression rate in resectable MTC,and its expression level has important clinical significance in evaluation of lymphatic metastasis.