常见肺癌血清肿瘤标志物在具有肺癌高危因素患者中的临床意义

发布时间：2018-01-14 11:06

  本文关键词：常见肺癌血清肿瘤标志物在具有肺癌高危因素患者中的临床意义　出处：《北京协和医学院》2015年硕士论文　论文类型：学位论文

  更多相关文章： 血清肿瘤标志物 小细胞肺癌 非小细胞肺癌 诊断价值

【摘要】：目的：探索常用肺癌相关血清学肿瘤标志物与肺癌诊断、病理类型、临床分期及表皮生长因子受体基因突变情况的关系。探索一组具有高敏感性和高特异性的肿瘤标志物谱。方法：根据入组标准选取2013年1月至2014年10月期间就诊于北京协和医院的患者,分别纳入肺癌组和良性肺疾病组。采集受试者10ml血液标本,检测血清ProGRP、CEA、SCC-Ag和Cyfra21-1四种肿瘤标志物水平,按检测制造商说明将血清ProGRP65pg/ml、SCC-Ag1.5ng/ml、Cyfra21-12.08ng/ml及 CEA5ng/ml视为高于正常水平。对不同肿瘤标记物计算诊断肺癌的敏感性、特异性、阳性预测值和阴性预测值。采用非参数秩和检验(两样本采用Mann-WhitneyU检验,多样本采用Kruskal-Wallis H检验)比较不同亚类的研究对象肿瘤标志物指标分布情况。通过受试者工作特征曲线(receiver operating characteristic,ROC)比较不同肿瘤标记物的诊断准确性。在所有统计学分析中,设定当p0.05时,具有统计学意义。结果：纳入受试者221名,包括113名肺癌患者、108名肺良性疾病。独立样本Kruskal-Wallis H检验证实血清ProGRP、SCC-Ag、Cyfra21-1肺癌组表达水平高于肺良性疾病组,有统计学意义(p=0.004, p=0.001, p=0.005)。单项检测时,Cyfra21-1诊断肺癌的敏感性56.6%,特异性63.3%, AUC-ROC为0.658;肿瘤标志物谱(联合ProGRP?SCC-Ag、Cyfra21-1和CEA)诊断肺癌的敏感性为72.9%,特异性为75%,AUC-ROC为0.739。在肺癌组中,SCC-Ag(1.5ng/ml)诊断肺鳞癌的敏感性为87.9%,特异性为91%,AUC-ROC为0.968；ProGRP(65pg/ml)诊断小细胞肺癌的敏感性为93.8%,特异性为99.0%,AUC-ROC 0.999.在肺癌患者中,晚期(Ⅲ+Ⅳ期)肺癌患者血清SCC-Ag、Cyfra21-1、CEA表达高于早期(Ⅰ+Ⅱ期)肺癌患者,有统计学意义(P=0.022,P=0.000,P=0.043)。在小细胞肺癌患者中,ED-SCLC患者血清ProGRP表达水平高于LD-SCLC患者(P=0.000)。EGFR基因组分析发现,CEA水平与EGFR突变型具有统计学相关性(p=0.000)。结论：研究结果表明,在具有肺癌高危因素患者中,以ProGRP、SCC-Ag、 Cyfra21-1及CEA组成的肿瘤标志物谱诊断肺癌敏感性有所提高,具有一定的辅助诊断价值。血清SCC-Ag诊断肺鳞癌、血清ProGRP诊断小细胞肺癌均具有较好的敏感性和特异性。四项肿瘤标记物与临床分期有相关性。血清CEA升高的肺腺癌是EGFR突变型患者的临床特点之一。
[Abstract]:Objective: to explore the relationship between serological tumor markers of lung cancer and the diagnosis and pathological types of lung cancer. The relationship between clinical stage and epidermal growth factor receptor gene mutation. To explore a group of highly sensitive and specific tumor markers. Methods:. According to the criteria selected from January 2013 to October 2014 in Beijing Union Hospital patients. 10 ml blood samples were collected from patients with lung cancer and benign lung diseases respectively, and the serum levels of four tumor markers (ProGRP CEA SCC-Ag and Cyfra21-1) were detected. The serum ProGRP 65pg / ml SCC-Ag 1.5ng / ml was measured according to the manufacturer's instructions. Cyfra21-12.08ng/ml and CEA5ng/ml were considered to be higher than the normal level. The sensitivity and specificity of different tumor markers in the diagnosis of lung cancer were calculated. Positive predictive value and negative predictive value. Nonparametric rank sum test (Mann-WhitneyU test for two samples) was used. Kruskal-Wallis H test was used to compare the distribution of tumor markers in different subgroups. Receiver operating characteristic. Roc) compared the diagnostic accuracy of different tumor markers. In all statistical analyses, the setting of p0.05 was statistically significant. Results: 221 subjects were included. There were 113 patients with lung cancer and 108 patients with benign lung diseases. Serum ProGRPg SCC-Ag was confirmed by independent Kruskal-Wallis H test. The expression level of Cyfra21-1 in lung cancer group was higher than that in benign lung disease group. The sensitivity of Cyfra21-1 in the diagnosis of lung cancer was 56. 6%, the specificity was 63. 3%, and the AUC-ROC was 0. 658; Tumor marker spectrum (combined with ProGRP? The sensitivity of SCC-AgAg-Cyfra21-1 and CEA in the diagnosis of lung cancer was 72.9, and the specificity was 75AUC-ROC (0.739) in lung cancer group. The sensitivity and specificity of SCC-AgN 1.5ng / ml in the diagnosis of lung squamous cell carcinoma were 87.9 and 91AUC-ROC 0.368, respectively. The sensitivity and specificity of ProGRPU 65pg / ml in the diagnosis of small cell lung cancer were 93.8 and 99.0, respectively. The expression of CEA in serum of patients with advanced stage (鈪，

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