术前血浆D-二聚体和血清CEA水平在预测肺腺癌淋巴结受累情况中的作用

The role of preoperative plasma D-dimer and serum CEA levels in predicting lymph node involvement in lung adenocarcinoma

目的分析肺腺癌患者术前血浆D-二聚体和血清癌胚抗原(CEA)水平与淋巴结受累情况的关系。方法选取2020年1月-2022年8月山西白求恩医院263例接受根治性肺切除术合并系统性淋巴结清扫的肺腺癌患者进行建模,定量分析术前血浆D-二聚体和血清CEA水平。依据淋巴结受累位置分为N0组、N1组、N2组,其中有无淋巴结受累为(N0 vs.N1+N2组),有无纵隔淋巴结受累为(N0+N1 vs.N2组)。建模后选取其他医院2022年1月-2023年1月符合纳入和排除标准的肺腺癌患者120例对预测结果进行外部验证,并采用Hosmer-Lemeshow检验进行校准度分析。结果肺腺癌患者术前血浆D-二聚体和血清CEA水平与其淋巴结转移个数之间的关系均成正相关(r=0.317,0.452,P均<0.05)。在有无淋巴结受累(N0 vs.N1+N2组)的受试者工作特征(ROC)曲线中,D-二聚体的曲线下面积(AUC)为0.690,最佳截断值为90.50μg/L;CEA的AUC为0.751,最佳截断值为3.35μg/L;二者联合检测的AUC、敏感性、特异性分别为0.748、0.57、0.72,与单独检测相比无明显优势,有淋巴结受累以CEA≥3.35μg/L为主。在有无纵隔淋巴结受累的ROC曲线中,D-二聚体的AUC为0.661,最佳截断值为140.50μg/L;CEA的AUC为0.744,最佳截断值为4.25μg/L;二者联合检测的AUC、敏感性、特异性分别为0.767、0.70、0.75,与单独检测相比有明显优势,有纵隔淋巴结受累以D-二聚体≥140.50μg/L且CEA≥4.25μg/L为主。经外部验证,建模组和检验组一致程度高,均具有较好的区分度和准确度。结论术前血浆D-二聚体和血清CEA水平对预测可手术肺腺癌患者淋巴结受累情况具有较高价值。

Objective The aim of this study was to investigate and analyze the relationship between preoperative plasma D-dimer and serum carcinoembryonic antigen(CEA)levels and lymph node involvement in patients with lung adenocarcinoma.Methods A total of 263 patients with lung adenocarcinoma who underwent radical pneumonectomy combined with systematic lymph node dissection in our hospital were selected for modeling,and the preoperative plasma D-dimer and serum CEA levels were quantitatively analyzed.Patients were divided into N0 group,N1 group,and N2 group according to the location of lymph node metastasis,with or without lymph node involvement(N0 vs.N1+N2 group);with or without mediastinal lymph node involvement(N0+N1 vs.N2 group).After modeling,120 lung adenocarcinoma patients who met the inclusion and exclusion criteria from January 2022 to January 2023 in other hospitals were selected for external verification of the prediction results,and the Hosmer-Lemeshow test was used for calibration analysis.Results The preoperative plasma D-dimer and serum CEA levels were positively correlated with the number of lymph node metastasis in patients with lung adenocarcinoma(P<0.05).In the receiver operator characteristic curve(ROC curve)of patients with or without lymph node involvement(N0 vs.N1+N2 group),the area under curve(AUC)of D-dimer was 0.690,and the optimal cut-off value was 90.50μg/L;the AUC of CEA was 0.751,and the optimal cut-off value was 3.35μg/L;the AUC,sensitivity and specificity of the two combined detection were 0.748,0.57 and 0.72,respectively,showing no obvious advantage compared with the single detection.Lymph node involvement was mainly CEA≥3.35μg/L;In the ROC curve of patients with and without mediastinal lymph node involvement,the AUC of D-dimer was 0.661,and the optimal cutoff value was 140.50μg/L;the AUC of CEA was 0.744,and the optimal cut-off value was 4.25μg/L;the AUC,sensitivity and specificity of the combined detection were 0.767,0.70 and 0.75,respectively,which had obvious advantages compared with single detection.Mediastinal lymph node involvement was mainly D-dimer≥140.50μg/L and CEA≥4.25μg/L.After external verification,the modeling group and the test group had a high degree of consistency,and both had good discrimination and calibration.Conclusion Preoperative plasma D-dimer and serum CEA levels had high value in predicting lymph node involvement in operable lung adenocarcinoma patients.