血清癌胚抗原细胞角蛋白19的可溶性片段纤维蛋白原D-二聚体和前白蛋白与非小细胞肺癌化疗患者预后的相关性分析

Correlation analysis of serum CEA,CYFRA21-1,FIB,D-dimer and prealbumin with the prognosis of patients with non-small cell lung cancer chemotherapy

目的分析血清癌胚抗原(CEA)、细胞角蛋白19的可溶性片段(CYFRA21-1)、纤维蛋白原(FIB)、D-二聚体(D-D)和前白蛋白(PAB)与非小细胞肺癌(NSCLC)化疗患者预后的相关性。方法采取回顾性研究,选择2021年6月至2023年6月医院收治120例行化疗治疗的NSCLC患者临床资料作为研究对象。均接受顺铂+吉西他滨(GD)方案化疗,随访12个月,根据随访期间存活情况进行分组,将存活患者临床资料纳入预后良好组,将病死患者临床资料纳入预后不良组。患者入院时均接受血清CEA、CYFRA21-1、FIB、D-D和PAB检测,统计患者基线资料。采用双变量相关性Pearson(N)分析,血清CEA、CYFRA21-1、FIB、D-D、PAB水平与NSCLC化疗患者生存期的关系;二元Logistic回归分析血清CEA、CYFRA21-1、FIB、D-D、PAB水平与NSCLC化疗患者预后不良之间的相关性;绘制受试者工作特征(ROC)曲线结果显示,血清CEA、CYFRA21-1、FIB、D-D、PAB水平预测NSCLC化疗患者预后不良的价值;采用样条函数与Logistics回归相结合的限制性立方样条法分析血清CEA、CYFRA21-1、FIB、D-D、PAB水平与NSCLC化疗患者预后不良的剂量反应关系。结果预后不良组分化程度为低分化、临床分期为Ⅲ~Ⅳ期患者占比高于预后良好组,CEA、CYFRA21-1、FIB、D-D高于预后良好组,PAB低于预后良好组(P<0.05);采用双变量相关性Pearson(N)分析显示,血清CEA、CYFRA21-1、FIB、D-D水平与NSCLC化疗患者生存期呈负相关(P<0.05),血清PAB水平与NSCLC化疗患者生存期呈正相关(P<0.05);二元Logistic回归分析结果显示,血清CEA、CYFRA21-1、FIB、D-D高表达是NSCLC化疗患者预后不良的危险因素(OR>1,P<0.05),血清PAB高表达是NSCLC化疗患者预后不良的保护因素(OR<1,P<0.05);绘制ROC曲线结果显示,血清CEA、CYFRA21-1、FIB、D-D、PAB水平预测NSCLC化疗患者预后情况的曲线下面积(AUC)均>0.70,有一定预测价值;NSCLC化疗患者血清CEA、CYFRA21-1、FIB、D-D水平与NSCLC化疗患者预后不良呈正相关,特别当血清CEA>24.53μg/ml、CYFRA21-1>7.82μg/ml、FIB>3.99 g/L、D-D>1.05μg/ml时,NSCLC化疗患者预后不良风险随血清CEA、CYFRA21-1、FIB、D-D水平升高而升高,NSCLC化疗患者PAB水平与NSCLC化疗患者预后不良呈负相关,当血清PAB<209.76 g/L时,NSCLC化疗患者预后不良风险随PAB水平降低而升高。结论血清CEA、CYFRA21-1、FIB、D-D和PAB水平与NSCLC化疗患者预后关系密切,上述指标可有效预测NSCLC化疗患者预后不良风险。

Objective To analyze the correlation between serum carcinoembryonic antigen(CEA),cytokeratin 19 soluble fragment(CYFRA21-1),fibrinogen(FIB),D-dimer(D-D),and prealbumin(PAB)and the prognosis of patients with non-small cell lung cancer(NSCLC)chemotherapy.Methods A retrospective study was conducted to select the clinical data of 120 NSCLC patients who were treated with chemotherapy in the hospital from June 2021 to June 2023 as the study subjects.All patients received cisplatin+gemcitabine(GD)chemotherapy and were followed up for 12 months.According to the survival during the follow-up period,the clinical data of the surviving patients were included in the good prognosis group,and the clinical data of the dead patients were included in the poor prognosis group.Serum CEA,CYFRA21-1,FIB,D-D,and PAB were detected on admission,and the baseline data of the patients were statistically analyzed.Bivariate correlation Pearson(N)analysis was used to analyze the relationship between serum CEA,CYFRA21-1,FIB,D-D,PAB levels and survival of NSCLC patients undergoing chemotherapy.Binary logistic regression analysis was used to analyze the correlation between serum CEA,CYFRA21-1,FIB,D-D,and PAB levels and poor prognosis in patients with NSCLC chemotherapy.The results of the receiver operating characteristic(ROC)curve showed that the levels of serum CEA,CYFRA21-1,FIB,D-D,and PAB predicted the poor prognosis of patients with NSCLC chemotherapy.The dose-response relationship between serum CEA,CYFRA21-1,FIB,D-D,and PAB levels and poor prognosis of NSCLC patients undergoing chemotherapy was analyzed by using the restricted cubic spline method combined with spline function and Logistics regression.Results The proportion of patients with poor differentiation and clinical stageⅢ-Ⅳin the poor prognosis group was higher than that in the good prognosis group,CEA,CYFRA21-1,FIB,and D-D were higher than those in the good prognosis group,and PAB was lower than that in the good prognosis group(P<0.05).Bivariate correlation Pearson(N)analysis showed that serum CEA,CYFRA21-1,FIB,and D-D levels were negatively correlated with the survival time of NSCLC patients undergoing chemotherapy(P<0.05),and serum PAB level was positively correlated with the survival time of NSCLC patients undergoing chemotherapy(P<0.05).The results of binary Logistic regression analysis showed that the high expression of serum CEA,CYFRA21-1,FIB,and D-D was a risk factor for poor prognosis in patients with NSCLC chemotherapy(OR>1,P<0.05),and the high expression of serum PAB was a protective factor for poor prognosis in patients with NSCLC chemotherapy(OR<1,P<0.05).The results of ROC curve showed that the AUC of serum CEA,CYFRA21-1,FIB,D-D,and PAB levels in predicting the prognosis of NSCLC patients with chemotherapy AUC was>0.70,which had a certain predictive value.The levels of serum CEA,CYFRA21-1,FIB,and D-D in patients with NSCLC chemotherapy were positively correlated with the poor prognosis of patients with NSCLC chemotherapy.Especially when serum CEA>24.53μg/ml,CYFRA21-1>7.82μg/ml,FIB>3.99g/L,D-D>1.05μg/ml,the risk of poor prognosis in patients with NSCLC chemotherapy increased with the increase of serum CEA,CYFRA21-1,FIB,and D-D levels.The level of PAB in patients with NSCLC chemotherapy was negatively correlated with the poor prognosis of patients with NSCLC chemotherapy.When serum PAB<209.76 g/L,the risk of poor prognosis in patients with NSCLC chemotherapy increased with the decrease in PAB level.Conclusion The levels of serum CEA,CYFRA21-1,FIB,D-D,and PAB are closely related to the prognosis of patients with NSCLC chemotherapy.The above indicators can effectively predict the risk of poor prognosis in patients with NSCLC chemotherapy.