基于倾向评分匹配法评估五种血清肿瘤标志物在肺癌辅助诊断中的应用价值

Value of five serum tumor markers in the diagnosis of lung cancer:A study based on propensity score-matched method

目的:基于倾向评分匹配法探讨血清五种肿瘤标志物联合检测对肺癌的诊断效能。方法:选择呼吸内科入院治疗的肺癌病人65例作为肺癌组,选择同期呼吸内科门诊和入院治疗的肺炎病人129例作为对照组。采用电化学发光法测定癌胚抗原(CEA)、神经特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1)、胃泌素释放肽前体(Pro-GRP)和鳞状细胞癌相关抗原(SCC)水平;经倾向评分匹配法去除混杂因素;绘制受试者工作特征曲线,比较五种血清肿瘤标志物的单独或联合诊断效能。结果:经1∶1倾向评分匹配法匹配肺癌组和对照组各57例,肺癌组CEA、CYFRA21-1、NSE水平均明显高于对照组(P<0.01),2组Pro-GRP和SCC水平差异均无统计学意义(P>0.05)。按照病理类型将匹配后的肺癌组分为鳞癌组20例和腺癌组37例,结果显示,腺癌组CYFRA21-1、CEA、NSE水平和鳞癌组NSE水平均明显高于对照组(P<0.01)。肺癌组血清CEA、CYFRA21-1和NSE对肺癌诊断均有较好的诊断效能(P<0.05)。多指标联合诊断效能高于单指标,不同联合策略之间诊断效能差异无统计学意义(P>0.05)。多指标联合对腺癌诊断的Youden指数高于鳞癌。结论:多指标联合可提高对肺癌的辅助诊断效能,尤其对腺癌更为明显。

Objective:To evaluate the combination diagnostic efficacy of five serum tumor markers in lung cancer based on propensity score-matched method.Methods:Sixty-five lung cancer patients and 129 pneumonia patients from respiratory medicine clinic were divided into the lung cancer group and control group,respectively.The serum levels of CEA,NSE,CYFRA21-1,Pro-GRP and SCC were detected using electrochemical luminescence method.The confounding factors were removed by propensity score-matched method.The receiver operating characteristic curves were drawn to compare the diagnostic efficacy of five serum tumor markers,either alone or in combination.Results:Fifty-seven cases were matched with lung cancer group and control group by 1∶1 propensity score matched method.The serum levels of CEA,CYFRA21-1 and NSE in lung cancer group were significantly higher than those in control group(P<0.01),and the differences of the serum levels of Pro-GRP and SCC between two groups were not statistically significant(P>0.05).According to the pathological types,the matched lung cancer group was divided into the squamous cell carcinoma group(20 cases)and adenocarcinoma group(37 cases),and the results showed that the levels of CYFRA21-1,CEA and NSE in adenocarcinoma group and NSE level in squamous cell carcinoma group were significantly higher than those in control group(P<0.01).The serum CEA,CYFRA21-1 and NSE in lung cancer group showed better diagnostic efficacy(P<0.05).The diagnostic efficiency of multi-indicator combination was higher than that of single indicator,and there was no statistical significance in diagnostic efficacy among different combinged strategies(P>0.05).The Youden index of multi-indicator combination in the diagnosis of adenocarcinoma was higher than that of squamous cell carcinoma.Conclusions:The combination of multiple indicators can improve the diagnostic efficiency of lung cancer,especially for adenocarcinoma.