^(18)F-FDG PET/CT联合肿瘤标志物诊断非ⅠA期局限性小细胞肺癌

^(18)F-FDG PET/CT combined with tumor markers for diagnosis of non stageⅠA limited-stage small cell lung cancer

目的观察^(18)F-FDG PET/CT联合肿瘤标志物诊断非ⅠA期局限性小细胞肺癌(LS-SCLC)的价值。方法纳入非ⅠA期LS-SCLC 87例(LS-SCLC组)、非ⅠA期非小细胞肺癌(NSCLC)137例(NSCLC组)及48例肺炎性病变(炎性组),对比患者一般资料、肿瘤标志物水平及PET/CT表现;以logistic回归分析评估不同参数诊断非ⅠA期LS-SCLC的效能。结果3组患者年龄、神经元特异性烯醇化酶(NSE)、胃泌素释放肽前体(ProGRP)、癌胚抗原(CEA)、鳞状细胞癌相关抗原(SCCA)及细胞角蛋白19片段(CYFRA21-1),以及病变最大径、最大标准摄取值(SUV_(max))、形态、毛刺征、长轴与支气管关系、淋巴结融合及淋巴结SUV_(max)高于原发灶占比差异均有统计学意义(P均<0.05)。联合毛刺征、NSE>23.5μg/L、ProGRP>111.8 ng/L、SCCA≤2.5μg/L及CYFRA21-1≤7.4μg/L鉴别LS-SCLC与NSCLC的曲线下面积(AUC)为0.91,均高于各单一参数(P均<0.05);联合SUV_(max)>8.1、NSE>19.4μg/L、ProGRP>72.5 ng/L和淋巴结融合鉴别LS-SCLC与肺内炎性病变的AUC为0.99,均高于单一参数(P均<0.05)。结论^(18)F-FDG PET/CT联合肿瘤标志物NSE和ProGRP有助于诊断非ⅠA期LS-SCLC。

Objective To observe the value of ^(18)F-FDG PET/CT combined with tumor markers for diagnosis of non stageⅠA limited-stage small cell lung cancer(LS-SCLC).Methods Totally 87 cases of non stageⅠA LS-SCLC(LS-SCLC group),137 of non stageⅠA non-small cell lung cancer(NSCLC,NSCLC group)and 48 cases of pulmonary inflammatory lesions(inflammatory group)were enrolled.Patients'general data,tumor marker levels and PET/CT findings were comparatively analyzed.Logistic regression analysis was performed to evaluate the efficacy of parameters for diagnosing non stageⅠA LS-SCLC.Results There were significant differences of patients'age,neuron-specific enolase(NSE),pro-gastrin-releasing peptide(ProGRP),carcinoembryonic antigen(CEA),squamous cell carcinoma antigen(SCCA)and cytokeratin-19-fragment(CYFRA21-1),as well as of the maximum lesion diameter,maximum standard uptake value(SUV_(max)),morphology,spiculation sign,relationship between long axis and bronchus,lymph node fusion and proportion of lymph node with higher SUV max than primary lesion among 3 groups(all P<0.05).The area under the curve(AUC)of the combination of spiculation sign,NSE>23.5μg/L,ProGRP>111.8 ng/L,SCCA≤2.5μg/L and CYFRA21-1≤7.4μg/L for differentiating LS-SCLC and NSCLC was 0.91,higher than that of each single parameter(all P<0.05).AUC of the combination of SUV_(max)>8.1,NSE>19.4μg/L,ProGRP>72.5 ng/L and lymph node fusion for differentiating LS-SCLC and pulmonary inflammatory lesions was 0.99,higher than each single parameter(all P<0.05).Conclusion ^(18)F-FDG PET/CT combined with tumor markers ProGRP and NSE was helpful for diagnosing non stageⅠA LS-SCLC.