肺腺癌分化程度的相关因素分析

Analysis on related factors of differentiation degree of lung adenocarcinoma

目的探讨肺腺癌分化程度的相关因素,从而更好地指导肺腺癌患者的个体化治疗及预后评估。方法回顾性分析2013年12月~2017年1月83例肺腺癌患者的临床、血清肿瘤标志物及正电子发射计算机断层显像(PET/CT)的资料。测量肺癌原发病灶的最大标准摄取值(SUVmax)并记录癌胚抗原(CEA)及细胞角蛋白19片段(cytokeratin 19 fragment,Cyfra21-1)的血清水平。对筛选出的38例明确分化程度的患者,采用秩和检验比较不同分化程度肺腺癌间年龄、CEA、Cyfra21-1及SUVmax的差异。采用Fisher精确概率检验比较两组患者性别、吸烟史的比率差异。二元Logistic回归分析寻找肺腺癌分化程度的独立预测因素。结果低分化肺腺癌患者的Cyfra21-1水平高于中高分化肺腺癌患者,差异有统计学意义(P <0.05);而性别、年龄、吸烟比例、SUVmax及CEA在两组肺腺癌间差异均无统计学意义(P> 0.05)。二元Logistic回归分析提示,仅血清Cyfra21-1水平(OR=2.111,95%CI:1.038~4.294)是肺腺癌分化程度的独立预测因素(P <0.05),且为危险因素。结论血清Cyfra21-1水平是肺腺癌分化程度的一个独立预测因素,且为危险因素。Cyfra21-1作为一个间接评估肺腺癌分化程度的潜在指标,对肺腺癌的个体化治疗和预后评估具有重要价值。

Objective To investigate the factors related to the differentiation degree of lung adenocarcinoma in order to better guide individualized treatment and prognosis evaluation of patients with lung adenocarcinoma. Methods Clinical data, serum tumor markers and data of positron emission tomography/computed tomography(PET/CT) of 83 patients with lung adenocarcinoma from December 2013 to January 2017 were retrospectively analyzed. The maximal standard uptake value(SUVmax) of primary lesions of lung cancer was measured and serum levels of CEA(carcinoembryonic antigen) and Cyfra21-1(cytokeratin 19 fragment) were recorded. For the 38 patients with definite differentiation degree, the rank-sum test was used to compare the differences in age, CEA, Cyfra21-1 and SUVmax among patients with lung adenocarcinomas of different differentiation degrees. Fisher’s exact probability test was used to compare the differences in gender and smoking history between the two groups. Binary logistic regression analysis was used to find independent predictors of differentiation degrees of lung adenocarcinoma. Results The level of Cyfra21-1 in patients with poorly differentiated lung adenocarcinoma was significantly higher than that in patients with moderately and highly differentiated lung adenocarcinoma. The difference between the two groups was statistically significant(P < 0.05). There was no statistically significant difference in gender, age, smoking history, SUVmax and CEA between the two groups(P > 0.05). Binary logistic regression analysis indicated that only serum Cyfra21-1 level(OR=2.111, 95%CI:1.038-4.294) was an independent predictor of differentiation of the lung adenocarcinoma(P < 0.05), and it was a risk factor. Conclusion Serum Cyfra21-1 level is an independent predictor of differentiation of lung adenocarcinoma and it is a risk factor. As a potential indicator for indirectly assessing the degree of differentiation of lung adenocarcinoma, Cyfra21-1 is of great value for individualized treatment and prognosis evaluation of lung adenocarcinoma.