血清肿瘤标志物CEA、CYFRA21-1、SCCAg、NSE、ProGRP在不同病理分型肺癌诊断中的应用价值

Diagnostic value of serum tumor markers CEA,CYFRA21-1,SCCAg,NSE and ProGRP for lung cancers of different pathological types

目的探讨癌胚抗原(CEA)、细胞角蛋白19的可溶性片段(CYFRA21-1)、鳞状细胞癌抗原(SCCAg)、神经元特异性烯醇化酶(NSE)和胃泌素释放肽前体(ProGRP)在不同病理分型肺癌诊断中的应用价值。方法选取临床诊断明确的肺腺癌(LADC)患者137例,肺鳞癌(LSCC)患者82例,小细胞肺癌(SCLC)患者59例,肺部良性病变(BCD)患者102例。检测所有患者血清肿瘤标志物,对比阳性率及浓度水平,采用ROC曲线进行分析,计算单独及联合检测的诊断效能。结果LADC组CEA阳性率及浓度水平高于其他组(P<0.05),LSCC组SCCAg阳性率及浓度水平高于其他组(P<0.05),SCLC组ProGRP、NSE阳性率及浓度水平高于其他组(P<0.05),CYFRA21-1在LADC组和LSCC组阳性率及浓度水平均最高。以BCD患者为对照,CEA在LADC患者中诊断灵敏度和特异度分别为62.8%和93.1%,SCCAg在LSCC患者中诊断灵敏度和特异度分别为64.6%和91.2%,CYFRA21-1在LADC患者和LSCC患者中诊断灵敏度最高。ProGRP在SCLC患者中诊断灵敏度和特异度分别为83.1%和98.0%;联合检测中,CYFRA21-1与CEA联合检测对LADC有较高灵敏度(78.8%)和特异度(86.3%),AUC为0.891,CYFRA21-1与SCCAg联合检测对LSCC有较高灵敏度(84.1%)和特异度(87.3%),AUC为0.912,NSE与ProGRP联合检测对SCLC有较高灵敏度(88.1%)和特异度(98.0%),AUC为0.952;在不同肺癌病理分型患者中,五个标志物联合检测与两个标志物联合检测相比较均没有统计学差异(P>0.05)。结论CEA、CYFRA21-1、SCCAg、NSE、ProGRP与肺癌病理分型相关,可作为肺癌诊断的相关指标。

Objective To evaluate the diagnostic value of the serum tumor markers carcinoembryonic antigen(CEA),cytokeratin-19-fragment(CYFRA21-1),squamous cell carcinoma associated antigen(SCCAg),neuron-specificenolase(NSE)and pro-gastrin-releasing peptide(ProGRP)for lung cancers of different pathological types.Methods This study was conducted among patients with established diagnoses of lung adenocarcinoma(LADC,n=137),lung squamous cell carcinoma(LSCC,n=82),small cell lung carcinoma(SCLC,n=59),and benign chest disease(BCD,n=102).The serum tumor markers were detected for all the patients for comparison of the positivity rates and their serum levels.ROC curve was used for analysis of the diagnostic efficacy of these tumor markers either alone or in different combinations.Results In patients with LADC,the positivity rate and serum level of CEA were significantly higher than those in the other groups(P<0.05);the patients with LSCC had the highest positivity rate and serum level of SCCAg among the 4 groups(P<0.05).The positivity rates and serum levels of ProGRP and NSE were significantly higher in SCLC group than in the other groups(P<0.05).CYFRA21-1 showed the highest positivity rate and serum level in LADC group and LSCC group.With the patients with BCD as control,CEA showed a diagnostic sensitivity of 62.8%and a specificity of 93.1%for LADC,and the sensitivity and specificity of SCCAg for diagnosing LSCC were 64.6%and 91.2%,respectively.CYFRA21-1 had the highest diagnostic sensitivity for LADC and LSCC.The diagnostic sensitivity and specificity of ProGRP for SCLC were 83.1%and 98.0%,respectively.When combined,CYFRA21-1 and CEA showed a high sensitivity(78.8%)and specificity(86.3%)for diagnosing LADC with an AUC of 0.891;CYFRA21-1 and SCCAg had a high sensitivity(84.1%)and specificity(87.3%)for diagnosing LSCC with an AUC of 0.912.NSE combined with ProGRP was highly sensitive(88.1%)and specific(98.0%)for diagnosis of SCLC,with an AUC of 0.952.For lung cancers of different pathological types,the combination of all the 5 tumor markers showed no significant differences in the diagnostic power from a combined detection with any two of the markers(P>0.05).Conclusion CEA,CYFRA21-1,SCCAg,NSE and ProGRP are all related to the pathological type of lung cancers and can be used in different combinations as useful diagnostic indicators for lung cancers.