肿瘤标志物诊断肺癌转移的临床价值

Clinical value of tumor markers in the diagnosis of lung cancer metastasis

目的:检测肿瘤标志物在肺癌与肺癌并转移患者中的水平差异,并分析其鉴别诊断价值。方法:纳入388例肺癌患者及67例肺癌并转移患者,采集血液样本,采用凝集素亲和方法检测肿瘤异常蛋白(TAP),采用化学发光免疫分析法检测糖类抗原125(CA125)、癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、糖类抗原50(CA50)、铁蛋白(FRT)、神经元特异性烯醇化酶(NSE)、鳞状细胞癌抗原(SCC)。比较上述肿瘤标志物在肺癌与肺癌并转移患者中的水平差异,利用受试者工作特征曲线(ROC),分析肿瘤标志物对两组患者的鉴别诊断价值。利用Logistic回归分析鉴定肺癌转移的风险因素。Spearman相关性分析患者肿瘤标志物之间的相关性。结果:CEA、CYFRA21-1及NSE在肺癌并转移患者中的水平明显高于肺癌患者(P<0.05),而其他肿瘤标志物在两组患者之间无明显差异(P>0.05)。与各自的参考区间相比,TAP在肺癌及肺癌并转移患者中的阳性率最高(>98%),SCC阳性率最低(<10%),其他指标的阳性率介于10%~65%。肺癌并转移患者CEA阳性率明显高于肺癌患者(62.69%vs 43.8%,P<0.05)。ROC分析结果显示,CEA对两组患者的鉴别效能最优(特异性:82%、敏感性:42%)。联合指标分析显示,与其他指标联合并不能明显提升CEA的鉴别诊断价值(P>0.05)。Logistic回归分析显示,CEA是肺癌转移的风险因素。相关性分析显示,在肺癌与肺癌并转移患者中,各肿瘤标志物之间的相关性不一致。结论:与肺癌患者组相比,肺癌并转移患者中的CEA阳性率及水平均明显升高,对肺癌转移的诊断具有一定的临床意义。

Objective:To evaluate the value of tumor markers in differential diagnosis of lung cancer and metastatic lung cancer.Methods:Blood samples were collected from patients with lung cancer(n=388)and metastatic lung cancer(n=67).TAP was detected by using lectin affinity method.The chemiluminescence immunoassay assay was used to detect of CA125,CEA,CYFRA21-1,CA50,FRT,NSE and SCC.ROC analysis was used to evaluate the differential diagnostic value of tumor markers for lung cancer and metastatic lung cancer.Logistic regression analysis was used to identify the risk factors for metastatic lung cancer.Spearman's rank correlation analysis was used to estimate the correlation among different tumor markers.Results:CEA,CYFRA21-1 and NSE levels were higher in patients with metastatic lung cancer than that in patients with lung cancer(P<0.05),while other tumor markers showed no significant difference(P>0.05).Compared with the respective reference intervals,the positive rate of TAP was the highest(>98%)in patients with lung cancer and metastatic lung cancer,while SCC had the lowest positive rate(<10%),and the positive rate of other tumor markers ranged 10%~65%.In patients with metastatic lung cancer,the positive rate and level of CEA were both significantly higher than that in patients with lung cancer(62.69%vs 43.8%,P<0.05).ROC analysis showed that CEA had the optimal efficacy in differential diagnosis of lung cancer and metastatic lung cancer(specificity:82%,sensitivity:42%).Combined index analysis showed that combining with other indexes could not improve the differential diagnostic value of CEA(P>0.05).Logistic regression analysis showed that CEA was a risk factor for lung cancer metastasis.Correlation analysis showed that the correlation among tumor markers was inconsistent in patients with lung cancer and metastatic lung cancer.Conclusion:Compared with the lung cancer patients,both the positive rate and level of CEA in patients with metastatic lung cancer were significantly increased,which would be helpful in diagnosis of lung cancer metastasis.