食管癌患者血清CEA、SCC和Cyfra21-1含量检测及临床意义

Significance of CEA,SCC and Cyfra21-1 serum test in esophageal cancer

目的 探讨血清肿瘤标志物癌胚抗原 (CEA)、鳞状细胞癌相关性抗原 (SCC)和角化素蛋白片段 19(Cyfra2 1 1)在食管癌的诊断、治疗和预后判断及随访中的作用。方法 以电发光免疫测定法 (ECLIA)和微粒酶联免疫测定法 (MEIA)检测 2 0 6例食管癌患者术前和其中 71例术后血清中CEA、Cyfra2 1 1和SCC的水平。检测结果采用SPSS 10 .0统计软件进行t检验和 χ2 检验。结果 肿瘤体积愈大、病期愈晚、肿瘤浸润愈深 ,患者术前血清CEA、SCC和Cyfra2 1 1总体水平愈高 ,早期患者水平较低。三者中 ,CEA和Cyfra2 1 1的个体差异较大 ,Cyfra2 1 1相关性最好。术后检测血清的 71例中 ,92 .9%的患者三种血清标志物降至正常。全组患者CEA和Cyfra2 1 1的阳性率分别为 2 9.1%和4 5 .1% ,两者联合检测阳性率为 5 7.3%。 16 5例手术切除者Ⅰ、Ⅱ、Ⅲ期的CEA阳性率分别为 16 .6 %、2 6 .8%和 30 .8% ;Cyfra2 1 1分别为 2 7.8%、37.5 %和 5 0 .5 % ;两者联合检测阳性率分别为 38.9%、5 0 .0 %和 6 3.7%。结论 血清CEA、SCC、Cyfra2 1 1联合检测可用于食管癌的辅助诊断以及对病期及预后的判断。三者中Cyfra2 1 1更有意义。

Objective To study the clinical significance of serum CEA, SCC and Cyfra21-1 test in the diagnosis, prediction of prognosis and postoperative monitor of recurrence in esophageal cancer. Methods The concentration of serum CEA and Cyfra21-1 was measured by electrochemiluminescence immunoassay (ECLIA) using Elecsys 2010, CEA kit and Cyfra21-1 kit. Serum SCC was measured by microparticle enzyme immunoassay (MEIA) using IMx System and SCC kit. Serum of 206 patients with esophageal cancer (203 squamous cell carcinoma, 2 small cell carcinoma and 1 adenosquamous carcinoma) was measured preoperatively, 71 of whom also measued 8 to 12 days after resection. Results The cut-off value of CEA and Cyfra21-1 was ≤3.25 ng/ml and ≤2.61 ng/ml, which were determined by the data of 45 healthy Chinese measured during the same period. The positive ratios of serum CEA and Cyfra21-1 in 206 cases were 29.1% and 45.1%. The combined positive ratio of CEA and Cyfra21-1 was 57.3%. The CEA positive ratios, according to the pathological stage of 165 resectable patients, were 16.6% (stage Ⅰ), 26.8% (Ⅱ) and 30.8% (Ⅲ). For Cyfra21-1, they were 27.8 %, 37.5% and 50.5%. For CEA combined with Cyfra21-1, they were 38.9%, 50.0% and 63.7%. The mean value of CEA, SCC and Cyfra21-1 (especially SCC and Cyfra21-1) was found to be well correlated with the tumor volume, TNM stage and depth of tumor invasion. Patient with bulky tumor or advanced tumor (T4) usually had much higher mean value than those with early stage tumors. One week after radical resection, the level of the three tumor markers fell to normal level in 92.9% of 71 patients. The level of serum CEA and Cyfra21-1 varied greatly in a small part of the patients. Extremely elevated serum CEA and Cyfra21-1 usually indicated advanced lesion or tumor metastasis. Conclusion Preoperative and postoperative measurement of serum CEA, SCC and Cyfra21-1 (especially Cyfra21-1) is helpful in the diagnosis, prediction of prognosis and monitor of postoperative recurrence in patients with esophageal cancer.