^(18)F-FDG PET/CT联合肿瘤标志物ProGRP与NSE在ⅠA期小细胞肺癌诊断及鉴别诊断中的价值

Value of ^(18)F-FDG PET/CT combined with tumor markers ProGRP and NSE in diagnosis and differential diagnosis of stageⅠA small cell lung cancer

目的分析^(18)F-FDG PET/CT联合肿瘤标志物胃泌素释放肽前体(ProGRP)与神经元特异性烯醇化酶(NSE)在ⅠA期小细胞肺癌(SCLC)诊断及鉴别诊断中的价值。方法回顾性分析2017年6月至2021年10月间在青岛大学附属青岛市中心医院经临床证实为ⅠA期的肺癌患者113例[男75例、女38例,年龄32~79岁;70例腺癌、25例鳞状细胞癌、18例SCLC;将腺癌和鳞状细胞癌合并为非SCLC(NSCLC)]和肺内孤立性良性结节30例(男21例、女9例,年龄37~77岁)。所有患者行^(18)F-FDG PET/CT检查并在检查前后2周内行肺癌相关血清肿瘤标志物检测,采用χ^(2)检验、Fisher确切概率法和Kruskal-Wallis秩和检验比较不同组患者的临床资料、影像学表现和肿瘤标志物水平。通过logistic回归分析筛选SCLC独立危险因素,采用ROC曲线分析不同指标在SCLC诊断中的价值。结果SCLC、NSCLC及良性结节3组患者的SUV_(max)、分叶征、毛刺征、钙化、胸膜牵拉征、ProGRP、NSE和癌胚抗原(CEA)的差异有统计学意义(H值:14.06~20.54,χ^(2)值:8.16~14.95,均P<0.05)。SCLC组的分叶征多于良性结节组[12/18和26.7%(8/30);χ^(2)=7.41,P=0.007],毛刺征[2/18和51.6%(49/95);χ^(2)=10.01,P=0.002]及胸膜牵拉征[1/18和35.8%(34/95);χ^(2)=6.47,P=0.011]少于NSCLC组,SUV_(max)高于良性结节组[7.4(5.8,9.0)和2.3(1.4,5.1);H=51.82,P<0.001],ProGRP水平高于NSCLC组、良性结节组[64.0(40.1,84.8)和38.7(26.9,47.6)、36.7(29.1,40.5)ng/L;H值:36.13、43.96,P值:0.002、0.001],NSE水平高于良性结节组[12.4(10.9,14.5)和7.4(5.4,11.8)μg/L;H=40.53,P=0.001]。与NSCLC鉴别时,毛刺征[比值比(OR)=0.043,95%CI:0.004~0.450,P=0.009]与ProGRP(OR=1.083,95%CI:1.035~1.133,P<0.001)是预测SCLC的独立危险因素,二者联合诊断SCLC的AUC为0.875,灵敏度和特异性为14/18和84.2%(80/95);与良性结节鉴别时,SUV_(max)(OR=2.706,95%CI:1.099~6.662,P=0.030)、ProGRP(OR=1.165,95%CI:1.009~1.344,P=0.038)、NSE(OR=1.639,95%CI:1.016~2.645,P=0.043)是预测SCLC的独立危险因素,三者联合诊断SCLC的AUC为0.985,灵敏度和特异性为17/18和96.7%(29/30)。结论^(18)F-FDG PET/CT联合肿瘤标志物ProGRP和NSE有助于提高ⅠA期SCLC的诊断及鉴别诊断效能。

Objective To explore the value of ^(18)F-FDG PET/CT combined with pro-gastrin-releasing peptide(ProGRP)and neuron-specific enolase(NSE)in diagnosis and differential diagnosis of stageⅠA small cell lung cancer(SCLC).Methods From June 2017 to October 2021,113 patients(75 males,38 females;age 32-79 years)with stageⅠA lung cancer(70 with adenocarcinoma,25 with squamous cell carcinoma,18 with SCLC;patients with adenocarcinoma and squamous cell carcinoma were combined into non-SCLC(NSCLC)group)and 30 patients with benign pulmonary nodule(21 males,9 females;age 37-77 years)from the Affiliated Qingdao Central Hospital of Qingdao University were retrospectively analyzed.All patients were examined by ^(18)F-FDG PET/CT and serum tumor markers associated with lung cancer.Differences of the clinical,imaging and tumor markers data among different groups were analyzed byχ^(2) test,Fisher exact test and Kruskal-Wallis rank sum test.Independent risk factors were analyzed by logistic regression analysis and ROC curve analysis was used to analyze the value of different predictive factors in diagnosis and differential diagnosis of SCLC.Results There were significant differences in SUV_(max),lobulation sign,spiculation sign,calcification,pleural traction sign,ProGRP,NSE and carcinoembryonic antigen(CEA)among SCLC,NSCLC and benign nodules groups(H values:14.06-20.54,χ^(2) values:8.16-14.95,all P<0.05),in which lobulation sign of SCLC was more than that of benign nodules(12/18 vs 26.7%(8/30);χ^(2)=7.41,P=0.007),spiculation sign(2/18 vs 51.6%(49/95);χ^(2)=10.01,P=0.002)and pleural traction sign(1/18 vs 35.8%(34/95);χ^(2)=6.47,P=0.011)were less than those of NSCLC,SUV_(max) was higher than that of benign nodules(7.4(5.8,9.0)vs 2.3(1.4,5.1);H=51.82,P<0.001),ProGRP was higher than that of NSCLC and benign nodules(64.0(40.1,84.8)vs 38.7(26.9,47.6),36.7(29.1,40.5)ng/L;H values:36.13,43.96,P values:0.002,0.001)and NSE was higher than that of benign nodules(12.4(10.9,14.5)vs 7.4(5.4,11.8)μg/L;H=40.53,P=0.001).When differentiated SCLC from NSCLC,spiculation sign(odds ratio(OR)=0.043,95%CI:0.004-0.450,P=0.009)and ProGRP(OR=1.083,95%CI:1.035-1.133,P<0.001)were independent risk factors for SCLC,and the AUC of the two factors combination was 0.875,with the sensitivity and specificity of 14/18 and 84.2%(80/95).When differentiated SCLC from benign nodules,SUV_(max)(OR=2.706,95%CI:1.099-6.662,P=0.030),ProGRP(OR=1.165,95%CI:1.009-1.344,P=0.038)and NSE(OR=1.639,95%CI:1.016-2.645,P=0.043)were independent risk factors for SCLC,and the AUC of the three factors combination was 0.985,with the sensitivity and specificity of 17/18 and 96.7%(29/30).Conclusion ^(18)F-FDG PET/CT combined with tumor markers ProGRP and NSE is helpful to improve the diagnosis and differential diagnosis of stageⅠA SCLC.