外周血组织金属蛋白酶抑制剂1癌胚抗原细胞角蛋白-19片段对周围型肺癌患者术后复发转移的预测价值

Prognostic value of peripheral blood metalloproteinase inhibitors 1,carcinoembryonic antigen,cytokeratin-19 fragment in postoperative recurrence and metastasis of patients with peripheral lung cancer

目的探讨外周血组织金属蛋白酶抑制剂1(TIMP-1)、癌胚抗原(CEA)、细胞角蛋白-19片段(CYFRA21-1)对周围型肺癌患者术后复发转移的预测诊疗价值。方法选择2018年10月至2021年10月于河南省邓州市中心医院进行手术切除治疗且在术后1年内出现复发转移的周围型肺癌患者42例,将其作为复发转移组,选择同期在院内接受手术切除治疗且在1年内未出现复发转移的周围型肺癌患者65例,将其作为未复发转移组,另选择45名同期于院内进行健康体检的人群将其作为健康对照组。将3组研究对象基线资料进行对比,将3组研究对象术后TIMP-1、CEA、CYFRA21-1水平进行对比,采用多因素Logistic回归分析对周围型肺癌患者术后复发转移的危险因素进行分析,采用受试者工作特征(ROC)曲线对TIMP-1、CEA、CYFRA21-1水平预测周围型肺癌患者术后复发转移的价值进行分析。结果复发转移组患者中有吸烟史、TNM分期为Ⅲ期的患者占比64%(27/42)、57%(24/42)相较于未复发转移组升高35%(23/65)、35%(23/65)(P均<0.05);复发转移组患者TIMP-1、CEA、CYFRA21-1水平(249±30)pg/ml、(16.0±4.8)ng/ml、(4.6±1.2)ng/ml均比未复发转移组和健康对照组(150±30)pg/ml、(3.4±1.5)ng/ml、(3.0±1.4)ng/ml和(141±19)pg/ml、(1.3±0.4)ng/ml、(1.3±0.3)ng/ml高(P均<0.05);多因素Logistic回归分析结果得出,周围型肺癌患者术后复发转移的危险因素为TIMP-1、CEA、CYFRA21-1(OR=1.904、2.020、1.775,P均<0.05);TIMP-1、CEA、CYFRA21-1水平预测周围型肺癌患者术后复发转移的AUC值分别为0.811、0.735、0.774,而将上述指标联合检测的AUC值为0.914,高于单独检测上述3项指标(P均<0.05)。结论周围型肺癌患者术后复发转移组患者TIMP-1、CEA、CYFRA21-1水平相较于未复发转移组患者升高,且周围型肺癌患者术后复发转移的危险因素为TIMP-1、CEA、CYFRA21-1,对3项指标联合检测应用于周围型肺癌患者术后复发转移的预测价值比单独检测的价值高。

Objective To investigate the value of metalloproteinase inhibitor 1(TIMP-1),carcinoembryonic antigen(CEA)and cytokeratin-19 fragment(CYFRA21-1)in predicting the recurrence and metastasis of peripheral lung cancer patients after surgery.Methods A total of 42 patients with peripheral lung cancer who underwent surgical resection in Dengzhou Central Hospital in Henan Province from October 2018 to October 2021 and developed recurrent metastasis within 1 year after surgery were selected as the recurrence and metastasis group,and 65 patients with peripheral lung cancer who underwent surgical resection in the hospital during the same period and did not have recurrence and metastasis within 1 year were selected as the non-recurrent metastasis group,and 45 patients who underwent physical examination in the hospital during the same period were selected as the healthy control group.The baseline data of the three groups of subjects were compared,and the postoperative TIMP-1,CEA and CYFRA21-1 levels of the three groups of subjects were compared.Multifactorial Logistic regression analysis was used to analyze the risk factors of postoperative recurrence and metastasis in patients with peripheral lung cancer.The value of TIMP-1,CEA and CYFRA21-1 levels in predicting postoperative recurrence and metastasis in patients with peripheral lung cancer was analyzed by receiver operating characteristic(ROC)curve.Results The proportion of patients with smoking history and TNM stageⅢin the recurrence and metastasis group was 64%(27/42)and 57%(24/42)higher than that in the non-recurrence and metastasis group by 35%(23/65)and 35%(23/65)(all P<0.05).The levels of TIMP-1,CEA and CYFRA21-1 in patients with recurrence and metastasis were(249±30)pg/ml,(16.0±4.8)ng/mL and(4.6±1.2)ng/ml compared with those in non-recurrence and metastasis group and healthy control group(150±30)pg/ml and(141±19)pg/ml,(3.4±1.5)ng/ml,(3.0±1.4)ng/ml,(1.3±0.4)ng/ml,(1.3±0.3)ng/ml high(all P<0.05).Multifactorial Logistic regression analysis showed that the risk factors for postoperative recurrence and metastasis in patients with peripheral lung cancer were TIMP-1,CEA,CYFRA21-1 levels(OR=1.904,2.020,1.775,all P<0.05).The AUC value of TIMP-1,CEA and CYFRA21-1 in predicting postoperative recurrence and metastasis of peripheral lung cancer patients was 0.811,0.735 and 0.774,respectively,while the AUC value of combined detection of the above indicators was 0.914,which was higher than that of single detection of the above three indicators(all P<0.05).Conclusion The levels of TIMP-1,CEA and CYFRA21-1 in patients with postoperative recurrence and metastasis of peripheral lung cancer were higher than those in patients with non-recurrence and metastasis,and the risk factors for postoperative recurrence and metastasis of peripheral lung cancer patients were TIMP-1,CEA and CYFRA21-1 levels.The combined detection of the three indexes has a higher value in predicting postoperative recurrence and metastasis in patients with peripheral lung cancer than that of single detection.