血清proGRP、Ctn、CEA在甲状腺髓样癌鉴别诊断和预测颈侧区淋巴结转移中的价值

Value of serum proGRP,Ctn and CEA in differential diagnosis of medullary thyroid carcinoma and prediction of cervical lymph node metastasis

目的:研究术前血清胃泌素释放肽前体(proGRP)、降钙素(Ctn)和癌胚抗原(CEA)在甲状腺髓样癌(MTC)鉴别诊断和预测颈侧区淋巴结转移中的价值。方法:选取41例MTC(有颈侧区淋巴结转移者22例,无转移者19例)患者(MTC组)和50例分化型甲状腺癌(DTC)患者(DTC组)。比较两组术前血清proGRP、Ctn和CEA水平,采用受试者工作特征(ROC)曲线分析血清proGRP、Ctn和CEA诊断MTC及判断MTC患者颈侧区淋巴结转移的价值。结果:MTC组术前血清proGRP、Ctn和CEA水平均高于DTC组,有颈侧区淋巴结转移的MTC患者高于无转移患者(P<0.001)。术前血清proGRP、Ctn和CEA单独诊断MTC的截断值[AUC(95%CI)]分别为105.00 ng/L[0.927(0.866~0.988)]、124.02 ng/L[0.958(0.914~1.000)]和8.49μg/L[0.887(0.807~0.967)],敏感度分别为87.8%、90.2%、82.9%,特异度分别为92.0%、100.0%、96.0%。proGRP与Ctn联合诊断MTC的敏感度为92.7%、特异度为92.0%,CEA与Ctn联合诊断MTC的敏感度为92.7%、特异度为98.0%。proGRP、Ctn和CEA联合诊断MTC的敏感度为95.1%,特异度为92.0%。术前血清proGRP、Ctn和CEA预测MTC患者颈侧区淋巴结转移的截断值[AUC(95%CI)]分别为565.00 ng/L[0.847(0.732~0.962)]、1578.25 ng/L[0.882(0.782~0.981)]和45.64μg/L[0.830(0.709~0.952)]。结论:血清proGRP、Ctn、CEA水平检测对MTC的辅助诊断有一定价值,联合检测可提高MTC检出率,且有助于术前预测MTC患者颈侧区淋巴结转移情况。

Aim:To investigate the value of preoperative serum pro-gastrin-releasing peptide(proGRP),calcitonin(Ctn)and carcinoembryonic antigen(CEA)in differential diagnosis and prediction of cervical lymph node metastasis in medullary thyroid carcinoma(MTC).Methods:A total of 41 patients with MTC(22 patients with cervical lymph node metastasis and 19 patients without)(MTC group)and 50 differentiated thyroid cancer(DTC)patients(DTC group)were selected.The expression levels of serum proGRP,Ctn and CEA were compared between the 2 groups before surgery,and the receiver operating characteristic(ROC)curve was used to analyze the value of serum proGRP,Ctn and CEA in diagnosing MTC and judging cervical lymph node metastasis in patients with MTC.Results:The preoperative serum proGRP,Ctn and CEA expression levels in the MTC group were higher than those in the DTC group,and the MTC patients with cervical lymph node metastasis were higher than those without cervical lymph node metastasis(P<0.001).The cut-off values[AUC(95%CI)]of preoperative serum proGRP,Ctn and CEA alone for diagnosing MTC were 105.00 ng/L[0.927(0.866-0.988)],124.02 ng/L[0.958(0.914-1.000)]and 8.49μg/L[0.887(0.807-0.967)].The sensitivity was 87.8%,90.2%,82.9%,and the specificity was 92.0%,100.0%,96.0%,respectively.The sensitivity and specificity of proGRP combined with Ctn in the diagnosis of MTC were 92.7%and 92.0%,respectively.The sensitivity and specificity of CEA and Ctn in the diagnosis of MTC were 92.7%and 98.0%,respectively.The sensitivity and specificity of proGRP,Ctn and CEA in the diagnosis of MTC were 95.1%and 92.0%,respectively.The cut-off values[AUC(95%CI)]of preoperative serum proGRP,Ctn and CEA for the diagnosis of cervical lymph node metastasis in MTC patients were 565.00 ng/L[0.847(0.732-0.962)],1578.25 ng/L[0.882(0.782-0.981)],and 45.64μg/L[0.830(0.709-0.952)].Conclusion:Serum proGRP,Ctn and CEA levels have a certain value in the auxiliary diagnosis of MTC.Combined with 3 indicators can improve the detection rate of MTC and help to predict the lymph node metastasis in the lateral cervical region of MTC patients before operation.