血清细胞角蛋白19片段抗原、糖类抗原125和50水平在肺癌中的诊断价值
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摘要
目的探讨血清细胞角蛋白19片段抗原(CYFRA21-1)、糖类抗原125(CA125)和糖类抗原50(CA50)水平在肺癌诊断中的应用价值。方法回顾性分析泰安市中心医院肿瘤科2012年1月至2013年12月收治的肺癌患者233例(研究组),其中非小细胞肺癌181例(腺癌129例,鳞癌52例),小细胞癌47例,其他类型5例;同期30例肺良性病变患者作为对照组。电化学发光法检测患者血清CYFRA21-1、CA125和CA50水平,比较3种标志物在肺癌不同病理类型患者中的水平以及联合检测对肺腺癌诊断和TNM分期的诊断价值,Kaplan-Meier生存曲线分析血清中3项标志物单项阳性和多项阳性的肺腺癌患者的生存时间。结果腺癌组血清CA125和CA50[(125. 06±42. 98) U/mL,(17. 43±8. 51) U/mL]水平明显高于鳞癌组[(65. 06±39. 03) U/mL,(11. 28±9. 01) U/mL]和小细胞癌组[(70. 32±49. 88) U/mL,(7. 43±6. 07) U/mL](腺癌与鳞癌比较,CA125:q=18. 21,P=0. 01,CA50:q=3. 98,P=0. 05;腺癌与小细胞癌比较,CA125:q=16. 64,P=0. 03,CA50:q=5. 98,P=0. 03),腺癌组血清CYFRA21-1水平[(12. 28±7. 08)μg/L]高于小细胞癌组[(7. 07±6. 23)μg/L](q=5. 12,P=0. 03);腺癌TNM分期中,Ⅰ期患者的CYFRA21-1、CA125水平[(9. 12±8. 09)μg/L,(35. 23±18. 77) U/mL]明显低于Ⅳ期患者[(48. 40±13. 61)μg/L,(179. 36±33. 19) U/mL](CYFRA21-1:q=8. 28,P=0. 02; CA125:q=31. 21,P=0. 00); 3项标志物联合检测敏感度为89. 97%,特异度为85. 09%; 3项标志物单项阳性患者的生存时间长于多项阳性的肺腺癌患者(χ~2=2. 91,P <0. 01)。结论血清CYFRA21-1、CA125和CA50水平检测在肺癌诊断、分期和预后中具有重要作用。
Objective To explore the value of serum cytokeratin 19 fragment antigen( CYFRA21-1),carbohydrate antigen 125( CA125) and carbohydrate antigen 50( CA50) levels in the diagnosis of lung cancer.Methods A retrospective analysis of 233 cases of lung cancer admitted to the Department of Oncology from January 2012 to December 2013 in Tai'an Central Hospital,including 181 cases of non small cell lung cancer( 129 cases of adenocarcinoma,52 cases of squamous cell carcinoma),47 cases of small cell carcinoma,5 cases of other types and 30 cases of benign lung lesions in the same period as control group. The serum levels of CYFRA21-1,CA125 and CA50 were detected by electrochemiluminescence. The levels of the 3 markers in patients with different pathological types of lung cancer and the diagnostic value of combined detection on the diagnosis of lung adenocarcinoma and TNM staging were compared,and the Kaplan-Meier survival curve was used to analyze the relationship between the patient' s life cycle of the single positive and multiple positive lung adenocarcinoma of the 3 markers in the serum. Results The levels of CA125 and CA50 were significantly higher in the adenocarcinoma group [( 125. 06±42. 98) U/mL,( 17. 43±8. 51) U/mL] than those in the squamous cell carcinoma group [( 65. 06±39. 03) U/mL,( 11. 28± 9. 01) U/mL],and the small cell carcinoma group [( 70. 32± 49. 88) U/mL,( 7. 43±6. 07) U/mL]( adenocarcinoma compared with squamous cell carcinoma,CA125: q = 18. 21,P = 0. 01,CA50: q = 3. 98,P = 0. 05; adenocarcinoma compared with small cell carcinoma,CA125: q = 16. 64,P = 0. 03,CA50: q = 5. 98,P = 0. 03). The levels of CYFRA21-1[( 12. 28±7. 08) μg/L] in adenocarcinoma was higher than that of small cell carcinoma group [( 7. 07±6. 23) μg/L]( q = 5. 12,P = 0. 03). In the TNM stage of cancer,the levels of CYFRA21-1 and CA125 in stage Ⅰ [( 9. 12±8. 09) μg/L,( 35. 23 ± 18. 77) U/mL] were significantly lower than that of stage Ⅳ patients [( 48. 40±13. 61) μg/L,( 179. 36± 33. 19) U/mL]( CYFRA21-1: q = 8. 28,P = 0. 02; CA125: q =31. 21,P = 0. 00); the sensitivity of the 3 markers combined detection was 89. 97%,while the specificity was 85. 09%,and the survival period of the 3 marker single positive patients was longer than that of multiple positive lung adenocarcinoma( χ~2= 2. 91,P <0. 01). Conclusion Serum CYFRA21-1,CA125 and CA50 play important roles in the diagnosis,staging and prognosis of lung cancer.
Objective To explore the value of serum cytokeratin 19 fragment antigen( CYFRA21-1),carbohydrate antigen 125( CA125) and carbohydrate antigen 50( CA50) levels in the diagnosis of lung cancer.Methods A retrospective analysis of 233 cases of lung cancer admitted to the Department of Oncology from January 2012 to December 2013 in Tai'an Central Hospital,including 181 cases of non small cell lung cancer( 129 cases of adenocarcinoma,52 cases of squamous cell carcinoma),47 cases of small cell carcinoma,5 cases of other types and 30 cases of benign lung lesions in the same period as control group. The serum levels of CYFRA21-1,CA125 and CA50 were detected by electrochemiluminescence. The levels of the 3 markers in patients with different pathological types of lung cancer and the diagnostic value of combined detection on the diagnosis of lung adenocarcinoma and TNM staging were compared,and the Kaplan-Meier survival curve was used to analyze the relationship between the patient' s life cycle of the single positive and multiple positive lung adenocarcinoma of the 3 markers in the serum. Results The levels of CA125 and CA50 were significantly higher in the adenocarcinoma group [( 125. 06±42. 98) U/mL,( 17. 43±8. 51) U/mL] than those in the squamous cell carcinoma group [( 65. 06±39. 03) U/mL,( 11. 28± 9. 01) U/mL],and the small cell carcinoma group [( 70. 32± 49. 88) U/mL,( 7. 43±6. 07) U/mL]( adenocarcinoma compared with squamous cell carcinoma,CA125: q = 18. 21,P = 0. 01,CA50: q = 3. 98,P = 0. 05; adenocarcinoma compared with small cell carcinoma,CA125: q = 16. 64,P = 0. 03,CA50: q = 5. 98,P = 0. 03). The levels of CYFRA21-1[( 12. 28±7. 08) μg/L] in adenocarcinoma was higher than that of small cell carcinoma group [( 7. 07±6. 23) μg/L]( q = 5. 12,P = 0. 03). In the TNM stage of cancer,the levels of CYFRA21-1 and CA125 in stage Ⅰ [( 9. 12±8. 09) μg/L,( 35. 23 ± 18. 77) U/mL] were significantly lower than that of stage Ⅳ patients [( 48. 40±13. 61) μg/L,( 179. 36± 33. 19) U/mL]( CYFRA21-1: q = 8. 28,P = 0. 02; CA125: q =31. 21,P = 0. 00); the sensitivity of the 3 markers combined detection was 89. 97%,while the specificity was 85. 09%,and the survival period of the 3 marker single positive patients was longer than that of multiple positive lung adenocarcinoma( χ~2= 2. 91,P <0. 01). Conclusion Serum CYFRA21-1,CA125 and CA50 play important roles in the diagnosis,staging and prognosis of lung cancer.
引文
[1]寇仁业,孙桂武,王强修,等.联合检测肺癌患者血清铁蛋白和癌胚抗原的临床观察[J].癌症,1995(2):137-138.
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[5]彭彦,王燕,郝学志,等.多项肺系统肿瘤标志物异常在晚期肺腺癌治疗中的作用[J].中国肺癌杂志,2017,20(10):690-694.
[6] Zeng Y,Bao J,Zhao Y,et al.A sensitive label-free electrochemical immunosensor for detection of CYFRA21-1 based on 3D graphene with gold nanopaticle modified electrode[J]. Talanta, 2018(178):122-128.
[7] Yoshiike F,Koizumi T,Yoneyama A,et al. Thymic squamous cell carcinoma producing parathyroid hormone-relatedprotein and CYFRA 21-1[J]. Intern Med,2004,43(6):493-495.
[8] Mishra A,Singh N,Sahu DK,et al.33P Expression of biomarkers IDH1,CEA,TPA and CYFRA21-1 in peripheral blood and tissue of non-small cell lung carcinoma patients detected by real-time PCR[J]. J Thorac Oncol,2018,13(4):S18.
[9] Zeng Y,Bao J,Zhao Y,et al. A sandwich-type electrochemical immunoassay for ultrasensitive detection of non-small cell lung cancer biomarker CYFRA21-1[J]. Bioelectrochemistry, 2018(120):183-189.
[10]陈一超,辇伟奇,冉静,等.肿瘤标志物联合检测对肺癌诊断、病理分型和临床分期的临床价值[J].国际检验医学杂志,2018,39(1):32-37.
[11] Hamd-Ghadareh S,Salimi A,Fathi F,et al.An amplified comparative fluorescence resonance energy transfer immunosensing of CA125tumor marker and ovarian cancer cells using green and economic carbon dots for bio-applications in labeling,imaging and sensing[J].Biosens Bioelectron,2017(96):308-316.
[12] Zhou X,Wang H,Wang X. Preoperative CA125 and fibrinogen in patients with endometrial cancer:a risk model for predicting lymphovascular space invasion[J]. J Gynecol Oncol,2017,28(2):e11.
[13] Babamiri B,Hallaj R,Salimi A.Ultrasensitive electrochemiluminescence immunoassay for simultaneous determination of CA125 and CA15-3tumor markers based on PAMAM-sulfanilic acid-Ru(bpy)32+and PAMAM-CdTe@CdS nanocomposite[J]. Biosens Bioelectron,2018(99):353-360.
[14]马乐群,李新房,王斌.胃癌患者血清s LAG-3、PARP-1、CA50含量与手术切除病灶中癌基因表达的相关性[J].海南医学院学报,2017,23(14):1957-1960.
[15]罗洪.胰腺癌组织中Krüppel样转录因子9表达量与血清肿瘤标志物及病灶内细胞侵袭的相关关系[J].海南医学院学报,2017,23(9):1241-1243,1247.
[16]闵磊,曹军卫,乔治,等.DR-70~(TM)和CA50肺癌免疫测定的应用价值[J].氨基酸和生物资源,2002(2):69-70.
[17] Ma L,Xie XW,Wang HY,et al. Clinical evaluation of tumor markers for diagnosis in patients with non-small cell lung cancer in China[J]. Asian Pac J Cancer Prev,2015,16(12):4891-4894.
[2]郭桂芳,谢汝华,杨安奎,等.晚期上颌窦鳞癌组织中GST-π和PCNA的表达与预后的关系[J].癌症,2005,24(10):1267-1271.
[3] Shepherd FA,Crowley J,Van Houtte P,et al. The International Association for the Study of Lung Cancer lung cancer staging project:proposals regarding the clinical staging of small cell lung cancer in the forthcoming(seventh)edition of the tumor,node,metastasis classification for lung cancer[J]. J Thorac Oncol,2007,2(12):1067-1077.
[4]李道胜,班媛媛,叶红,等.非小细胞肺癌淋巴结转移规律的临床病理学特征分析[J/CD].中华诊断学电子杂志,2016,4(4):249-252.
[5]彭彦,王燕,郝学志,等.多项肺系统肿瘤标志物异常在晚期肺腺癌治疗中的作用[J].中国肺癌杂志,2017,20(10):690-694.
[6] Zeng Y,Bao J,Zhao Y,et al.A sensitive label-free electrochemical immunosensor for detection of CYFRA21-1 based on 3D graphene with gold nanopaticle modified electrode[J]. Talanta, 2018(178):122-128.
[7] Yoshiike F,Koizumi T,Yoneyama A,et al. Thymic squamous cell carcinoma producing parathyroid hormone-relatedprotein and CYFRA 21-1[J]. Intern Med,2004,43(6):493-495.
[8] Mishra A,Singh N,Sahu DK,et al.33P Expression of biomarkers IDH1,CEA,TPA and CYFRA21-1 in peripheral blood and tissue of non-small cell lung carcinoma patients detected by real-time PCR[J]. J Thorac Oncol,2018,13(4):S18.
[9] Zeng Y,Bao J,Zhao Y,et al. A sandwich-type electrochemical immunoassay for ultrasensitive detection of non-small cell lung cancer biomarker CYFRA21-1[J]. Bioelectrochemistry, 2018(120):183-189.
[10]陈一超,辇伟奇,冉静,等.肿瘤标志物联合检测对肺癌诊断、病理分型和临床分期的临床价值[J].国际检验医学杂志,2018,39(1):32-37.
[11] Hamd-Ghadareh S,Salimi A,Fathi F,et al.An amplified comparative fluorescence resonance energy transfer immunosensing of CA125tumor marker and ovarian cancer cells using green and economic carbon dots for bio-applications in labeling,imaging and sensing[J].Biosens Bioelectron,2017(96):308-316.
[12] Zhou X,Wang H,Wang X. Preoperative CA125 and fibrinogen in patients with endometrial cancer:a risk model for predicting lymphovascular space invasion[J]. J Gynecol Oncol,2017,28(2):e11.
[13] Babamiri B,Hallaj R,Salimi A.Ultrasensitive electrochemiluminescence immunoassay for simultaneous determination of CA125 and CA15-3tumor markers based on PAMAM-sulfanilic acid-Ru(bpy)32+and PAMAM-CdTe@CdS nanocomposite[J]. Biosens Bioelectron,2018(99):353-360.
[14]马乐群,李新房,王斌.胃癌患者血清s LAG-3、PARP-1、CA50含量与手术切除病灶中癌基因表达的相关性[J].海南医学院学报,2017,23(14):1957-1960.
[15]罗洪.胰腺癌组织中Krüppel样转录因子9表达量与血清肿瘤标志物及病灶内细胞侵袭的相关关系[J].海南医学院学报,2017,23(9):1241-1243,1247.
[16]闵磊,曹军卫,乔治,等.DR-70~(TM)和CA50肺癌免疫测定的应用价值[J].氨基酸和生物资源,2002(2):69-70.
[17] Ma L,Xie XW,Wang HY,et al. Clinical evaluation of tumor markers for diagnosis in patients with non-small cell lung cancer in China[J]. Asian Pac J Cancer Prev,2015,16(12):4891-4894.