术前叶酸受体阳性循环肿瘤细胞对早期肺结节良恶性的诊断价值

Preoperative diagnostic efficacy of folic acid receptor positive circulating tumor cells in benign and malignant pulmonary nodules

目的探讨叶酸受体(folate receptor,FR)阳性循环肿瘤细胞(circulating tumor cell,CTC)检测对早期肺结节良恶性的鉴别诊断价值。方法前瞻性纳入2018年3月至2021年7月首都医科大学附属北京胸科医院收入院治疗的疑似肺癌的肺结节患者550例,收集患者的人口学特征、临床特征、肿瘤标志物数据及FR阳性CTC(FR+CTC)检测结果,分析FR+CTC对早期肺结节良恶性的鉴别诊断价值。结果550例患者术后病理确诊肺癌406例,肺良性病变144例,其中肺癌的FR+CTC水平为9.35(7.40,12.00)FU/3ml,明显高于肺良性病变患者的7.40(5.90,9.50)FU/3ml,差异有显著性(P<0.01)。FR+CTC诊断肺癌的受试者工作特征曲线下面积(area under curve,AUC)为0.706(95%CI 0.656~0.757),截断值为6.24FU/3ml,敏感度为96.3%,特异度为32.6%,联合其他肿瘤标志物后,AUC提高至0.739,但与FR+CTC相比差异无显著性(P=0.368)。结论FR+CTC检测对早期肺癌的诊断效能较好,可为肺癌的筛查与诊断提供参考。

Objective To explore the diagnostic value of folate receptor positive circulating tumor cells(FR+CTC)in lung cancer.Method A total of 550 patients with suspected lung cancer admitted to the Chest Hospital of Beijing from March 2018 to July 2021 were included in the study.The demographic characteristics,clinical characteristics and tumor markers of the patients were collected,and 3ml blood sample was collected from patients for FR+CTC detection.Result The median FR+CTC levels were 9.35(7.40,12.00)FU/3ml and 7.40(5.90,9.50)FU/3ml in lung cancer(n=406)and benign lung disease(n=144),respectively,and the difference was statistically significant(P<0.01).When the cut-off value was 6.24FU/3ml,the sensitivity was 96.3%,the specificity was 32.6%,and the area under curve(AUC)the receiver operating characteristic(ROC)of FR+CTC for lung cancer was 0.706(95%CI 0.656-0.757).While FR+CTC combined with other tumor markers,the AUC increased to 0.739,but the difference was not statistically significant compared with FR+CTC(P=0.368).Conclusion The detection of FR+CTC has a good diagnostic efficiency for early lung cancer,and the combination of FR+CTC and tumor markers can provide basis for the diagnosis and screening of lung cancer.