Value of low-dose chest CT, carcinoembryonic antigen and Cyfra21-1 levels in the diagnosis of early lung cancer
-
摘要:
目的 探讨低剂量胸部CT扫描与癌胚抗原（CEA）、细胞角蛋白19片段抗原（Cyfra21-1）在早期肺癌检查中的价值。 方法 选取2019年1月~2021年1月在我院就诊的肺部亚实性结节患者108例，均给予低剂量CT扫描，经病理确诊为早期肺癌患者76例（其中原位癌34例，微浸润性癌22例，浸润性癌20例），非肺癌患者32例，比较肺癌和非肺癌患者血清CEA、Cyfra21-1水平差异，分析CT联合血清CEA、Cyfra21-1诊断早期肺癌的价值。 结果 肺癌患者血清CEA、Cyfra21-1明显高于非肺癌患者（P < 0.05）；CT联合血清CEA、Cyfra21-1诊断早期肺癌的敏感度和阴性预测值明显高于CT检查（P < 0.05）；浸润性癌病灶直径、CT值明显高于原位癌和微浸润性癌（P < 0.05）；原位癌、微浸润性癌和浸润性癌患者CEA、Cyfra21-1的差异无统计学意义（P>0.05）；病灶直径、CT值诊断浸润性癌的ROC曲线下面积分别为0.941和0.816（P < 0.05），截断值分别为15.86 mm和-422.52 Hu，敏感度分别为90.00%和65.00%，特异性分别为91.10%和89.30%。 结论 低剂量胸部CT与CEA、Cyfra21-1水平在早期肺癌诊断中有较好的价值，同时病灶直径及CT值在鉴别浸润性癌中有一定应用价值。 -
关键词:
- 低剂量CT扫描 /
- 癌胚抗原 /
- 细胞角蛋白19片段抗原 /
- 肺癌 /
- 浸润性癌
Abstract:Objective To investigate the value of low-dose chest CT scan, carcinoembryonic antigen (CEA) and cytokeratin 19 fragment antigen (Cyfra21-1) in the diagnosis of early lung cancer. Methods A total of 108 patients with pulmonary sub solid nodules from January 2019 to January 2021 in our hospital were selected. All patients were given low-dose CT scanning. The serum CEA and CYFRA21-1 in patients with lung cancer and non lung cancer were compared, and the value of CT combined with serum CEA and CYFRA21-1 in the diagnosis of early lung cancer was analyzed. Results Seventy-six patients were pathologically diagnosed as early lung cancer (including 34 cases of carcinoma in situ, 22 cases of micro invasive carcinoma and 20 cases of invasive carcinoma), and 32 patients were non lung cancer. The serum CEA and Cyfra21-1 in lung cancer patients were significantly higher than those in non-lung cancer patients (P < 0.05). The sensitivity and negative predictive value of CT combined with serum CEA and Cyfra21-1 in the diagnosis of early lung cancer were significantly higher than that of CT (P < 0.05). The diameter and CT values of invasive carcinoma were significantly higher than those of carcinoma in situ and microinvasive carcinoma (P < 0.05). There was no significant difference in CEA and Cyfra21-1 among patients with carcinoma in situ, microinvasive carcinoma and invasive carcinoma (P>0.05). The area under the ROC curve of lesion diameter and CT value for the diagnosis of invasive carcinoma were 0.941 and 0.816, respectively (P < 0.05), the cut-off value was 15.86 mm and -422.52 Hu respectively. The sensitivity were 90.00% and 65.00%, and the specificity were 91.10% and 89.30% respectively. Conclusion Low dose chest CT, CEA and Cyfra21-1 level have good value in the diagnosis of early lung cancer, and lesion diameter and CT value have certain application value in the differentiation of invasive cancer. -
图 1 某肺癌患者CT表现
右肺下叶外基底段混合型磨玻璃结节，直径约8 mm，病理结果显示为浸润性癌.
Figure 1. CT image of a lung cancer patient
表 1 早期肺癌和非肺癌患者一般资料比较
Table 1. Comparison of general data of patients with early lung cancer and non lung cancer
组别 男/女（n） 年龄（岁, Mean±SD） BMI（kg/m2, Mean±SD） 肺癌（n=76） 42/34 55.84±8.36 22.19±2.06 非肺癌（n=32） 22/10 56.90±7.84 22.03±2.17 t/χ2 1.697 -0.613 0.363 P 0.193 0.541 0.717 
下载: 导出CSV
表 2 肺癌和非肺癌患者血清CEA、Cyfra21-1水平比较
Table 2. Comparison of serum CEA and CYFRA21- 1 levels between lung cancer and non lung cancer patients (ng/mL, Mean±SD)
组别 CEA Cyfra21-1 肺癌（n=76） 18.84±3.10 2.15±0.78 非肺癌（n=32） 1.22±0.23 0.98±0.33 t 32.029 8.166 P < 0.001 < 0.001 CEA: 癌胚抗原；Cyfra21-1：细胞角蛋白19片段抗原.
下载: 导出CSV
表 3 CT联合血清CEA、Cyfra21-1水平诊断价值
Table 3. Diagnostic value of CT combined with serum CEA and CYFRA21-1 levels (%)
组别 敏感度 特异性 准确性 阳性预测值 阴性预测值 CT 75.00（57/76） 90.63（29/32） 79.63（86/108） 95.00（57/60） 60.42（29/48） CT联合血清CEA、Cyfra21-1 93.42（71/76） 78.13（25/32） 88.89（96/108） 91.03（71/78） 83.33（25/30） χ2 9.698 1.896 3.491 0.315 4.552 P 0.002 0.168 0.062 0.574 0.033
下载: 导出CSV
表 4 肺癌不同病理类型患者CT定量参数、血清CEA、Cyfra21-1比较
Table 4. Comparison of CT quantitative parameters, serum CEA and CYFRA21-1 in patients with different pathological types of lung cancer (Mean±SD)
组别 直径（mm） CT值（Hu） CEA（ng/mL） Cyfra21-1（ng/mL） 原位癌（n=34） 12.25±3.36 -565.54±102.36 78.15±3.06 2.08±0.82 微浸润性癌（n=22） 12.60±3.18 -532.18±98.87 78.90±3.31 2.17±0.91 浸润性癌（n=20） 19.84±4.10ab -403.36±101.15ab 79.95±4.25 2.25±0.96 F 12.264 10.054 1.032 0.987 P < 0.001 < 0.001 0.564 0.611 aP < 0.05 vs原位癌；bP < 0.05 vs微浸润性癌.
下载: 导出CSV
-
[1] 孙祝, 雍翔, 孙宇, 等. 调强放疗对比三维适形放疗治疗非小细胞肺癌的疗效及对血清CEA、CYFRA21-1的影响[J]. 实用癌症杂志, 2020, 35(5): 774-7. doi: 10.3969/j.isn.1001-5930.2020.05.021 [2] 李云峰, 刘贵林, 徐宝静, 等. CT影像学检查联合肿瘤标志物检测在肺结核合并肺癌中的诊断效能分析[J]. 中国临床医生杂志, 2019, 47(7): 789-91. doi: 10.3969/j.issn.2095-8552.2019.07.012 [3] 陈雯微. 血清CEA、CA125及cyfra21-1水平与中晚期非小细胞肺癌患者的临床特征与预后相关性分析[J]. 中国医师杂志, 2019, 21(11): 1714-6. doi: 10.3760/cma.j.issn.1008-1372.2019.11.030 [4] 李雪芹, 朱述阳. 血清CEA CA125及cyfra21-1水平对中晚期非小细胞肺癌患者预后的影响[J]. 河北医学, 2019, 25(11): 1761-4. doi: 10.3969/j.issn.1006-6233.2019.11.001 [5] 王建华, 杨敏. 纤支镜联合CYFRA21-1、CEA和CA125在肺癌诊断中的临床价值[J]. 贵州医药, 2020, 44(10): 1529-31. doi: 10.3969/j.issn.1000-744X.2020.10.005 [6] 周维平, 谷优玲, 林速建, 等. 肺孤立结节患者CT表现与患者血清中CEA、CYFER21-1、NSE及病理结果的关系[J]. 中国卫生检验杂志, 2019, 29(5): 596-8, 601. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201905029.htm [7] Kim B, Kim SW, Lim JY, et al. NCAPH is required for proliferation, migration and invasion of non-small-cell lung cancer cells[J]. Anticancer Res, 2020, 40(6): 3239-46. doi: 10.21873/anticanres.14305 [8] DeMaio A, Sterman D. Bronchoscopic intratumoural therapies for non-small cell lung cancer[J]. Eur Respir Rev, 2020, 29(156): 200028. doi: 10.1183/16000617.0028-2020 [9] Lee CN, Po-Chao Chiu F, Hsu CK. Cutaneous Cytomegalovirus (CMV) infection in a patient with metastasized lung cancer[J]. Clin Microbiol Infect, 2021, 27(4): 565-7. doi: 10.1016/j.cmi.2021.01.016 [10] Asano Y, Kashiwagi S, Kouhashi R, et al. A case of advanced breast cancer with altered biology by eribulin chemotherapy[J]. Gan Kagaku Ryoho Cancer Chemother, 2019, 46(13): 2330-2. http://www.ncbi.nlm.nih.gov/pubmed/32156921 [11] 张婷, 向波, 林勇平. 肿瘤标志物联合检测在肺癌辅助诊断中的预测价值[J]. 中华预防医学杂志, 2021, 55(6): 786-791. doi: 10.3760/cma.j.cn112150-20200715-01015 [12] Sone K, Oguri T, Ito K, et al. Predictive role of CYFRA21-1 and CEA for subsequent docetaxel in non-small cell lung cancer patients [J]. Anticancer Res, 2017, 37(9): 5125-31. http://www.ncbi.nlm.nih.gov/pubmed/28870944 [13] Shintani T, Matsuo Y, Iizuka Y, et al. Prognostic significance of serum CEA for non-small cell lung cancer patients receiving stereotactic body radiotherapy[J]. Anticancer Res, 2017, 37(9): 5161-7. http://d.wanfangdata.com.cn/periodical/7e8fb9be88d3822ffa21372082332f2d [14] Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer, 2015, 136(5): E359-86. http://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsRW5nTmV3UzIwMjEwMzAyEiA4YzBkOTYxM2MzNmYwNTc1MDA5ZTA1ZTMwZjA5ZjYyZBoIZmhyMWxmeHg%3D [15] Sattar M, Majid A. Lung cancer classification models using discriminant information of mutated genes in protein amino acids sequences[J]. Arab J Sci Eng, 2019, 44(4): 3197-211. doi: 10.1007/s13369-018-3468-8 [16] 廖栩鹤, 刘萌, 王荣福, 等. 肺腺癌患者18F-FDG PET/CT半定量参数与EGFR基因突变亚型的关系[J]. 中国介入影像与治疗学, 2020, 17(2): 98-103. https://www.cnki.com.cn/Article/CJFDTOTAL-JRYX202002014.htm [17] Tartarone A, Lerose R, Aieta M. Focus on lung cancer screening [J]. J Thorac Dis, 2020, 12(7): 3815-20. doi: 10.21037/jtd.2020.02.17 [18] Sokouti M, Sokouti M, Sokouti B. The role of biomarker genes in the diagnosis and treatment of nonsmall cell lung cancer[J]. Curr Respir Med Rev, 2019, 14(3): 142-8. doi: 10.2174/1573398X15666181219113646 [19] 孟庆成, 高朋瑞, 任鹏飞, 等. 肿瘤相关抗体谱结合CT征象鉴别早期肺腺癌亚型的初步探讨[J]. 中华医学杂志, 2019, 99(3): 204-8. doi: 10.3760/cma.j.issn.0376-2491.2019.03.010 [20] 盛俊卿, 李卫星, 贾祯, 等. 多层螺旋CT灌注成像联合血清CYFRA21-1、CEA、NSE对周围型非小细胞肺癌的诊断价值[J]. 解放军医学杂志, 2020, 45(5): 542-6. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJY202005015.htm [21] 钟周军. 迭代重建技术在低辐射剂量胸部检查中的应用[J]. 分子影像学杂志, 2015, 38(4): 323-4, 331. doi: 10.3969/j.issn.1674-4500.2015.04.04 [22] 祝萍, 徐晓俊, 张敏鸣. 肺腺癌患者表皮生长因子受体基因突变与CT征象相关性研究[J]. 中华实验外科杂志, 2019, 36(3): 579. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD201903022.htm [23] 陈聚兴, 高中博, 伍尚剑, 等. MRI联合CEA、CYFRA21-1检测对早期肺癌的诊断价值[J]. 检验医学与临床, 2020, 17(3): 368-70. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL202003023.htm [24] 陈雯微. 血清CEA、CA125及Cyfra21-1水平与中晚期非小细胞肺癌患者的临床特征与预后相关性分析[J]. 中国医师杂志, 2019, 21(11): 1714-6. doi: 10.3760/cma.j.issn.1008-1372.2019.11.030 [25] 任泽元, 钱树森. 高分辨率CT联合肺癌血清肿瘤标志物检测对早期肺癌的诊断价值[J]. 分子影像学杂志, 2020, 43(3): 457-61. doi: 10.12122/j.issn.1674-4500.2020.03.18 -
点击查看大图
图(2) / 表(4)
计量
- 文章访问数: 515
- HTML全文浏览量: 212
- PDF下载量: 18
- 被引次数: 0
