临床常用小细胞肺癌肿瘤标志物的诊断价值

Clinical diagnostic value of tumor markers related to small cell lung cancer

目的:分析临床常用的血清肿瘤标志物对小细胞肺癌(SCLC)的诊断与鉴别诊断价值,探讨SCLC适宜的肿瘤标志物检测方法。方法:回顾性分析2017年5月—2021年8月收治的肺癌病例资料,统计SCLC肿瘤标志物检测结果,选取检测率超过30%的肿瘤标志物进行研究,采用倾向性匹配(PSM)方法按1∶1比例分别匹配良性肺病、肺腺癌(ADC)和肺鳞癌(SqCC)病例,分析不同肿瘤标志物单独以及联合检测结果对SCLC的诊断与鉴别诊断价值。结果:231例SCLC中神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、甲胎蛋白(AFP)、糖类抗原125(CA125)、糖类抗原199(CA199)、鳞状上皮细胞癌抗原(SCC)、细胞角蛋白19片段抗原211(CA211)共7种血清肿瘤标志物纳入研究,与良性肺病组比较,SCLC患者的NSE、CA211和CEA表达水平高,NSE诊断价值最高(AUC值0.887 6)。SCLC广泛期NSE和CA211表达显著高于局限期。SCLC与ADC组比较,NSE表达水平高,CEA、CA125、SCC、CA211表达水平低,NSE、CEA及CA211联合检测鉴别诊断价值高(AUC=0.923 3)。SCLC与SqCC组比较,NSE和CEA表达水平高,SCC、CA211表达水平低,NSE与SCC联合检测鉴别诊断价值高(AUC=0.913 9)。结论:NSE、CEA、CA211、SCC在SCLC诊断与鉴别诊断中具有价值,SCLC广泛期NSE和CA211表达高于局限期。NSE、CEA及CA211联合检测有助于与ADC鉴别,NSE和SCC联合检测有助于与SqCC鉴别。

Objective:To explore the diagnostic and differential diagnostic value of commonly used serum tumor markers for small cell lung cancer(SCLC),and to screen the appropriate detection methods of tumor markers for SCLC.Methods::Patients with SCLC admitted from May 2017 to August 2021 were enrolled and matched with the corresponding number of benign lung disease patients,their statis⁃tics of the detection results of SCLC tumor markers were gathered,and the tumor markers with detec⁃tion rate over 30%were selected for research.Lung adenocarcinoma(ADC)and lung squamous cell carcinoma(SqCC)patients in the same hospital in a 1∶1 ratio by using the Propensity Score Match(PSM)method respectively to analyze the diagnostic efficacy of different tumor markers individually and jointly for SCLC patients.Results::Neuron⁃specific enolase(NSE),carcinoembryonic antigen(CEA),alpha fetoprotein(AFP),carbohydrate antigen125(CA125),carbohydrate antigen199(CA199),squamous cell carcinoma antigen(SCC),and cytokeratin marker(CA211)were included in the study.The expression level of NSE(P<0.001),CEA(P<0.001),and CA211(P<0.001)in SCLC group was higher than those in benign lung disease group.The diagnostic value of NSE was high(AUC=0.8876).The expressions of NSE and CA211 in patients with extensive SCLC were significantly higher than those in the local stage.Compared with ADC patients,the expression level of NSE(P<0.001),was higher in SCLC patients,while the expression level of CEA(P<0.001),CA125(P<0.001),SCC(P=0.03),and CA211(P=0.005)was lower.The combined detection of NSE,CEA,and CA211 had high differential diagnostic value(AUC=0.9233).Compared with SqCC group,the expression levels of NSE(P<0.001)and CEA(P<0.001)in SCLC group were higher,the expression levels of SCC(P<0.001)and CA211(P=0.007)were lower,and the com⁃bined detection of NSE and SCC had a higher differential diagnostic value(AUC=0.9139).Conclu⁃sion::NSE,CEA,and CA211 are valuable in the diagnosis of SCLC.The expression of NSE and CA211 in the extensive stage of SCLC is significantly higher than that in the limited stage.The com⁃bination of NSE,CEA,and CA211 is helpful in distinguish SCLC from ADC.When it comes to SqCC,combining NSE and SCC can be more applicable.