肺癌血清肿瘤标志物与病理特征及转移的关系

Relationship between serum tumor markers and pathological characteristics and metastasis of lung cancer

目的分析肺癌血清肿瘤标志物与病理特征及转移的关系。方法选取2018年1月-2019年6月成都市第三人民医院、北京大学第三医院收治的肺癌患者(n=100,肺癌组)、肺部良性病变者(n=80,良性组)、同期健康体检者(n=40,对照组),测定三组入院时神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1)、鳞状细胞癌抗原(SCC-Ag)、胃泌素释放肽前体(ProGRP)、糖类抗原125(CA125)、糖类抗原153(CA153)水平,分析上述6种血清肿瘤标志物与病理类型、TNM分期、转移的关系及对肺癌转移的预测价值。结果肺癌组入院时血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153水平明显高于良性组和对照组(P<0.05),良性组、对照组各指标比较差异亦有统计学意义(P<0.05)。肺癌患者中,腺癌CYFRA21-1、CA125、CA153水平高于鳞癌和小细胞肺癌,鳞癌SCC-Ag水平高于腺癌和小细胞肺癌,小细胞肺癌NSE、ProGRP水平高于鳞癌和腺癌(P<0.05)。随肺癌患者TNM分期增加,血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153水平有增加趋势(P<0.05);肺癌转移患者血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153水平高于未转移者,肝转移患者NSE、CYFRA21-1表达水平最高,骨转移患者SCC-Ag、CA125表达水平最高,脑转移患者ProGRP表达水平最高(P<0.05)。ROC曲线分析显示,血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153联合预测肺癌转移的曲线下面积为0.871,高于各指标单独预测。结论肺癌患者血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153呈高表达,且其表达水平均与肺癌病理类型、转移类型有一定关联,血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153联合对肺癌转移有较高预测价值。

Objective To analyze the relationship between serum tumor markers and pathological characteristics and metastasis of lung cancer.Methods Patients with lung cancer(n=100,lung cancer group)and patients with benign pulmonary lesions(n=80,benign group)who were admitted to the two hospitals between January 2018 and June 2019,and people(n=40,control group)who completed physical examination in the hospital during the same period were enrolled in the study.Levels of neuron-specific enolase(NSE),cytokeratin 19 fragment(CYFRA21-1),squamous cell carcinoma antigen(SCC-Ag),pro-gastrin-releasing peptide(ProGRP),carbohydrate antigen 125(CA125)and carbohydrate antigen153(CA153)in each group were determined at admission.The relationship between the above six serum tumor markers and pathological types,TNM stage and metastasis was analyzed.The predictive value of the 6 serum tumor markers in lung cancer metastases was analyzed.Results The levels of serum NSE,CYFRA21-1,SCC-Ag,ProGRP,CA125 and CA153 were significantly higher in the lung cancer group at admission than those in the benign group and the control group(P<0.05).In patients with lung cancer,the levels of CYFRA21-1,CA125 and CA153 in adenocarcinoma were higher than those in squamous cell carcinoma and small cell lung cancer.SCC-Ag level in squamous cell carcinoma was higher than that in adenocarcinoma or small cell lung cancer.Levels of NSE and ProGRP in small cell lung cancer were higher than those in squamous cell carcinoma or adenocarcinoma(P<0.05).With the increase of TNM stage of lung cancer,serum NSE,CYFRA21-1,SCC-Ag,ProGRP,CA125 and CA153 levels increased(P<0.05).The levels of serum NSE,CYFRA21-1,SCC-Ag,ProGRP,CA125 and CA153 in patients with lung cancer metastasis were higher than those without.The expression levels of NSE and CYFRA21-1 were the highest in patients with liver metastasis;the expression levels of SCC-Ag and CA125 were the highest in patients with bone metastasis,and the expression level of ProGRP was the highest in patients with brain metastasis(P<0.05).ROC curve analysis showed that the area under the curve of combined detection of serum NSE,CYFRA21-1,SCC-Ag,ProGRP,CA125 and CA153 for predicting lung cancer metastasis(0.871)was larger than those of single indicator detection alone.Conclusions Serum NSE,CYFRA21-1,SCC-Ag,ProGRP,CA125 and CA153 were highly expressed in patients with lung cancer.The tumor markers were related to the pathological type and metastasis type of lung cancer.The combination of serum NSE,CYFRA21-1,SCC-Ag,ProGRP,CA125 and CA153 should have high value in predicting metastases of lung cancer.