血清CEA、NSE联合影像学特征在肺癌分期及预后中的价值

The value of serum CEA and NSE combined with imaging features in lung cancer staging and prognosis

目的 探讨血清癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)联合影像学特征在肺癌的临床分期及预后的临床价值。方法 收集2016年1月至2018年12月宿州市第一人民医院肿瘤科肺癌患者70例作为肺癌组,另选取在本院进行体检的健康者70名作为对照组。采用全自动电化学发光法对受试者进行血清NSE和CEA水平的检测;采用CT记录肺癌患者肺结节影像学特征;比较肺癌不同分期(Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期)间血清NSE和CEA水平以及影像学特征;分析血清NSE、CEA水平与影像学特征的关系;采用ROC曲线分析患者血清NSE、CEA以及二者联合对肺癌不良预后的预测价值。结果 与对照组比较,肺癌组患者的血清NSE、CEA水平显著升高,差异有统计学意义(t=15.499、11.009,P<0.05)。患者血清NSE、CEA水平比较:Ⅰ期<Ⅱ期<Ⅲ期<Ⅳ期,组间比较差异均有统计学意义(P<0.05);与预后良好组患者比较,预后不良组患者的血清NSE、CEA水平显著升高,差异有统计学意义(t=8.488、5.839,P<0.05);与预后良好组患者比较,预后不良组患者的结节直径>5 mm、毛刺征、血管征、深分叶征、坏死空洞比例明显增多,差异有统计学意义(P<0.05)。患者结节直径>5 mm、有毛刺征、有血管征、有深分叶征、有坏死空洞的血清NSE、CEA水平明显高于结节直径≤5 mm、无毛刺征、无血管征、无深分叶征、无坏死空洞的患者,差异有统计学意义(P<0.05)。ROC结果显示,血清NSE、CEA二者联合诊断肺癌不良预后的AUC为0.829,敏感度为0.856,特异度为0.750。结论 肺癌患者血清中NSE、CEA水平与临床分期以及不良预后有关,血清NSE、CEA与影像学特征具有一定的关系,联合检测有望提升肺癌预后预测价值。

Objective To investigate the clinical value of serum carcinoembryonic antigen(CEA)and neuron-specific enolase(NSE)combined with imaging features for the clinical staging and prognosis of lung cancer. Methods A total of 70 patients with lung cancer in the Oncology Department of Suzhou First People’s Hospital from January 2016 to December 2018 were collected as the lung cancer group,and 70 healthy people who underwent physical examination in Suzhou First People’s Hospital were selected as the control group. The automatic electrochemiluminescence method was used to detect serum NSE and CEA levels in the subjects;CT was used to record the imaging features of lung nodules in patients with lung cancer;the serum NSE and CEA levels and imaging features among different stages of lung cancer(stageⅠ,stage Ⅱ,stageⅢ,stage Ⅳ)were compared;the relationship between serum NSE and CEA levels and imaging features was analyzed. The ROC curve was used to analyze the predictive value of serum NSE,CEA and the combination of the two on the poor prognosis of lung cancer of patients. Results Compared with the control group,the levels of serum NSE and CEA in the lung cancer group were significantly higher(t=15.499,11.009,P<0.05).Comparison of serum NSE and CEA levels in patients:stageⅠ< stageⅡ< stageⅢ< stage Ⅳ,there was significant difference between the two groups(P<0.05). Compared with the patients in the good prognosis group,the serum NSE and CEA levels of the patients in the poor prognosis group were significantly higher,the difference was statistically significant(t=8.488,5.839,P<0.05). Compared with the patients in the good prognosis group,the proportions of nodules > 5 mm,burr sign,vascular sign,deep paging sign,and necrotic cavity were significantly higher than those in the poor prognosis group,the difference was statistically significant(P<0.05). The serum NSE and CEA levels in patients with nodule diameter >5 mm,burr sign,vascular sign,deep paging sign and necrotic cavity were significantly higher than those in patients with nodule diameter ≤5 mm,no burr sign,no blood vessel sign,no deep paging sign and no necrotic cavity,and the difference was statistically significant(P<0.05). The ROC results showed that the AUC of serum NSE level for the diagnosis of poor prognosis of lung cancer was 0.737,the sensitivity was 0.761,and the specificity was 0.667;the AUC of serum CEA level for the diagnosis of poor prognosis of lung cancer was 0.817,the sensitivity was 0.783,and the specificity was 0.792;the AUC of the two combined diagnosis of poor prognosis of lung cancer was 0.829,the sensitivity was 0.856,and the specificity was 0.750. Conclusion Serum NSE and CEA levels in patients with lung cancer are related to clinical staging and poor prognosis. Serum NSE and CEA have a certain relationship with imaging characteristics. Combined detection is expected to improve the prognostic value of lung cancer.