血清肿瘤标志物在肺癌不同病理分型中的应用价值

Application Values of Serum Tumor Markers in Different Pathological Types of Lung Cancer

目的探讨血清肿瘤标志物癌胚抗原(CEA)、癌抗原125(CA125)、鳞状细胞癌抗原(SCC-Ag)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段抗原(CYFRA21-1)和胃泌素释放肽前体(ProGRP)在肺癌不同病理分型中的应用价值。方法选取2020年1—11月我院肺腺癌25例(肺腺癌组)、肺鳞癌25例(肺鳞癌组)、小细胞肺癌50例(小细胞肺癌组)和同期肺部良性疾病50例(肺部良性疾病组)。比较各组患者血清CEA、CA125、SCC-Ag、NSE、CYFRA21-1和ProGRP水平,以及肺腺癌组、肺鳞癌组及小细胞肺癌组血清肿瘤标志物阳性率差异,并绘制受试者工作特征曲线评价6种血清肿瘤标志物两两联合对肺腺癌、肺鳞癌、小细胞肺癌的诊断效能。结果肺癌组患者CEA、CA125、SCC-Ag、NSE、CYFRA21-1、ProGRP水平明显高于肺部良性疾病组患者(P<0.05,P<0.01)。肺腺癌患者CEA阳性率高于肺鳞癌、小细胞肺癌患者,肺鳞癌患者SCC-Ag、CYFRA21-1阳性率高于肺腺癌、小细胞肺癌患者,小细胞肺癌患者NSE、ProGRP阳性率高于肺腺癌、肺鳞癌患者,差异有统计学意义(P<0.05)。小细胞肺癌与非小细胞肺癌患者CEA、SCC-Ag、NSE、CYFRA21-1、ProGRP水平比较差异有统计学意义(P<0.01)。CEA联合CA125诊断肺腺癌的曲线下面积(AUC)为0.734,95%CI为0.619,0.829;SCC-Ag联合CYFRA21-1诊断肺鳞癌的AUC为0.925,95%CI为0.840,0.973;NSE联合ProGRP诊断小细胞肺癌的AUC为0.904,95%CI为0.829,0.954。结论血清肿瘤标志物CEA、CA125、SCC-Ag、NSE、CYFRA21-1、ProGRP在肺癌不同病理分型中有明显差异,联合检测可提高诊断效能,有助于临床医生预判肺癌类型。

Objective To investigate the application values of serum tumor markers carcinoembryonic antigen(CEA),cancer antigen 125(CA125),squamous cell carcinoma antigen(SCC-Ag),neuron specific enolase(NSE),cytokeratin 19 fragment antigen(CYFRA21-1)and gastrin releasing peptide precursor(ProGRP)in different pathological types of lung cancer.Methods A total of 25 patients with lung adenocarcinoma(lung adenocarcinoma group),25 patients with lung squamous cell carcinoma(SCC,lung SCC group),50 patients with small cell lung cancer(SCLC,SCLC group)and 50 patients with benign lung diseases(benign lung diseases group)from January to November 2020 were selected.Levels of serum CEA,CA125,SCC-Ag,NSE,CYFRA21-1 and ProGRP among all groups,and differences in positive rates of serum tumor markers among lung adenocarcinoma group,lung SCC group and SCLC group were compared.The receiver operating characteristic curve was drawn to evaluate diagnostic efficacies of combined two markers in the six serum tumor markers in lung adenocarcinoma,lung SCC and SCLC.Results Levels of CEA,CA125,SCC-Ag,NSE,CYFRA21-1 and ProGRP in lung cancer group were significantly higher than those in benign lung disease group(P<0.05,P<0.01).The positive rate of CEA in patients with lung adenocarcinoma were significantly higher than those in patients with lung SCC and SCLC,and positive rates of SCC-Ag and CYFRA21-1 in patients with lung SCC were significantly higher than those in patients with lung adenocarcinoma and SCLC,and positive rates of NSE and ProGRP in patients with SCLC were significantly higher than those in patients with lung adenocarcinoma and lung SCC(P<0.05).There were significant differences in levels of CEA,SCC-Ag,NSE,CYFRA21-1 and ProGRP between patients with SCLC and non-SCLC(P<0.01).The area under curve(AUC)of CEA combined with CA125 in diagnosis of lung adenocarcinoma was 0.734(95%CI:0.619,0.829).The AUC of SCC-Ag combined with CYFRA21-1 in diagnosis of lung SCC was 0.925(95%CI:0.840,0.973).The AUC of NSE combined with ProGRP in diagnosis of SCLC was 0.904(95%CI:0.829,0.954).Conclusion Serum tumor markers CEA,CA125,SCC-Ag,NSE,CYFRA21-1 and ProGRP have significant differences in patients with different pathological types of lung cancer.Combined detection may improve the diagnostic efficiency and help clinicians predict the types of lung cancer.