外周血肿瘤标志物对周围型肺癌切除术后复发转移的预测价值

The predictive value of peripheral blood tumor markers for recurrence and metastasis of peripheral lung cancer after resection

目的 分析周围型肺癌患者外周血组织金属蛋白酶抑制剂1(TIMP-1)、细胞角蛋白-19片段(CYFRA21-1)、基质金属蛋白酶9(MMP-9)对术后复发转移预测价值。方法 我院收治的周围型肺癌且术后1年内复发患者77例为复发组,同期收治且术后1年内未复发周围型肺癌患者91例为非复发组,同期健康体检者50例为对照组。检测三组血清CYFRA21-1、MMP-9、TIMP-1水平。比较不同血清CYFRA21-1、MMP-9、TIMP-1水平患者术后复发率;分析术后复发转移影响因素。评估TIMP-1、CYFRA21-1、MMP-9对患者术后复发预测价值。结果 复发组吸烟史和III期比例多于非复发组(P<0.05)。复发组CYFRA21-1、MMP-9、TIMP-1水平高于对照组和非复发组(P<0.05)。MMP-9、TIMP-1、CYFRA21-1低表达组复发率低于高表达组(P<0.05)。CYFRA21-1、MMP-9和TIMP-1水平是术后复发的影响因素。血清CYFRA21-1、MMP-9、TIMP-1评估肺癌患者复发转移的AUC分别为0.782、0.806、0.829,联合预测的AUC为0.923。结论 术后复发患者血清CYFRA21-1、MMP-9、TIMP-1高表达,三者高表达患者术后复发率高,对患者术后复发有一定预测价值,是术后复发危险因素。

Objective To analyze the predictive value of tissue inhibitor of matrix metalloproteinases-1(TIMP-1), cytokeratin-19,fragment 21-1(CYFRA21-1) and matrix metalloproteinase-9(MMP-9) in peripheral blood for recurrence and metastasis in patients with peripheral lung cancer.Methods Seventy-seven patients with peripheral lung cancer with recurrence within 1 year after surgery in our hospital were enrolled as a recurrence group. Another 91 patients with peripheral lung cancer without recurrence within 1 year after surgery were enrolled as a non-recurrence group. At the same period, 50 healthy subjects were enrolled as a control group. The levels of serum CYFRA21-1, MMP-9 and TIMP-1 were detected. The postoperative recurrence rates in patients with different levels of serum CYFRA21-1, MMP-9 and TIMP-1 were compared. The influencing factors of postoperative recurrence and metastasis were analyzed. The predictive value of CYFRA21-1, MMP-9 and TIMP-1 for postoperative recurrence was evaluated.Results The proportions of patients with smoking history and TNM staging at stage III in the recurrence group were significantly higher than those in the non-recurrence group(P<0.05). The levels of serum CYFRA21-1, MMP-9 and TIMP-1 in the recurrence group were higher than those in the control group and the non-recurrence group(P<0.05). The recurrence rates in the low-expression of CYFRA21-1, MMP-9 and TIMP-1 groups were lower than those in the corresponding high-expression groups(P<0.05). CYFRA21-1, MMP-9 and TIMP-1 were influencing factors of postoperative recurrence of peripheral lung cancer. Areas under ROC curve(AUC) of serum CYFRA21-1, MMP-9, and TIMP-1 for evaluating recurrence and metastasis in lung cancer patients were 0.782, 0.806, and 0.829, and combined detection of the three indicators was 0.923.Conclusion The levels of serum CYFRA21-1, MMP-9 and TIMP-1 are up-regulated in patients with postoperative recurrence. The postoperative recurrence rate is higher in patients with high expressions of CYFRA21-1, MMP-9 and TIMP-1. These three indicators have a certain predictive value for postoperative recurrence. They are risk factors for postoperative recurrence.