目的:血清游离轻链(free light chain,FLC)在多种疾病中表达异常,但其在肺癌中的表达尚不清楚,本研究旨在探讨血清FLC在肺癌中的表达及诊断价值.方法:选取2021年1至12月湖南师范大学附属湘东医院收治的80例肺癌患者作为肺癌组,另选取同时期的80例健康体检人员作为对照组.收集所有参与者的一般资料、血清κFLC和λFLC水平;收集肺癌组患者住院期间的相关临床指标[血清癌胚抗原(carcinoembryonic antigen,CEA)、细胞角蛋白-19片段抗原(cytokeratin fragment antigen 21-1,CYFRA21-1)水平,以及肿瘤直径、组织学分型、TNM分期、是否有淋巴结转移].比较肺癌组和对照组血清FLC[κFLC、λFLC、FLC(κ+λ)]的表达水平.将80例肺癌患者按性别、年龄、吸烟史、肿瘤直径、TNM分期、组织学分型、淋巴结转移进行分组,比较组间血清κFLC、λFLC表达水平的差异.采用受试者操作特征(receiver operating characteristic,ROC)曲线评价血清FLC水平单独及联合其他指标在肺癌中的诊断价值.结果:肺癌组血清FLC(κ+λ)、κFLC表达水平均显著高于对照组,差异均有统计学意义(均P＜0.001);而2组间血清λFLC表达水平的差异无统计学意义(P＞0.05).不同肿瘤直径、组织学分型、TNM分期的肺癌血清κFLC表达水平差异均无统计学意义(均P＞0.05);但是,有淋巴结转移的肺癌患者血清κFLC水平高于无淋巴结转移的肺癌患者,且差异有统计学意义(P=0.033).不同肿瘤直径、组织学分型肺癌患者的血清λFLC表达水平差异均无统计学意义(均P＞0.05);但是,TNM分期Ⅲ期+Ⅳ期、有淋巴结转移的肺癌患者血清λFLC表达水平分别高于TNM分期Ⅰ期+Ⅱ期、无淋巴结转移的肺癌患者,差异均有统计学意义(分别P=0.033,P=0.019).κFLC、CEA诊断肺癌的曲线下面积(area under the curve,AUC)差异无统计学意义(P=0.333).在2项联合诊断肺癌的指标中,κFLC+CYFRA21-1的诊断效能(AUC=0.875)及敏感性(71.3％)最高.κFLC+λFLC+CEA+CYFRA21-1联合诊断肺癌的AUC为0.915(95％CI0.860～0.953,P＜0.001).结论:血清FLC在肺癌中高表达,并且与肺癌的浸润和转移有关.血清FLC尤其是κFLC对肺癌的诊断具有价值,FLC、CEA、CYFRA21-1联合检测的诊断效能最佳.
Expression and diagnostic value of serum free light chain in lung cancer
Objective:The expression of serum free light chain(FLC)is abnormal in various diseases,but its role in lung cancer remains unclear.This study aims to investigate the expression and diagnostic value of serum FLC in lung cancer.Methods:A total of 80 lung cancer patients treated at Xiangdong Hospital,Hunan Normal University from January to December 2021 were selected as the lung cancer group.Another 80 healthy individuals undergoing routine physical examinations during the same period were chosen as the control group.General information and serum κFLC and λFLC levels were collected for all subjects.Clinical indicators such as serum carcinoembryonic antigen(CEA),cytokeratin fragment antigen 21-1(CYFRA21-1)levels,tumor diameter,histological type,TNM stage,and lymph node metastasis status were recorded for lung cancer patients.The expression levels of serum FLC[κFLC,λFLC,and FLC(κ+λ)]were compared between the lung cancer group and the control group.Lung cancer patients were grouped based on gender,age,smoking history,tumor diameter,TNM stage,histological type,and lymph node metastasis to compare differences in serum κFLC and λFLC levels.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic value of serum FLC alone and in combination with other indicators in lung cancer.Results:The expression levels of serum FLC(κ+λ)and κFLC were significantly higher in the lung cancer group than those in the control group(both P＜0.001),while there was no significant difference in serum λFLC levels between the 2 groups(P＞0.05).There were no significant differences in serum κFLC levels among lung cancer patients with different tumor diameters,histological types,or TNM stages(all P＞0.05);however,serum κFLC levels were higher in lung cancer patients with lymph node metastasis than in those without,with statistical significance(P=0.033).There were no significant differences in serum λFLC levels based on tumor diameter or histological type(both P＞0.05),but serumλFLC levels were higher in stage Ⅲ+Ⅳ and lymph node metastatic lung cancer patients compared to stage Ⅰ+Ⅱ and non-metastatic patients,with statistical significance(P=0.033 and P=0.019,respectively).The area under the curve(AUC)for κFLC and CEA in diagnosing lung cancer showed no significant difference(P=0.333).The combination ofκFLC+CYFRA21-1 had the highest diagnostic efficacy(AUC=0.875)and sensitivity(71.3％).The AUC for the combined diagnosis of κFLC+λFLC+CEA+CYFRA21-1 was 0.915(95％CI 0.860 to 0.953,P＜0.001).Conclusion:Serum FLC is highly expressed in lung cancer and is associated with its invasion and metastasis.Serum FLC,particularly κFLC,has diagnostic value for lung cancer,and the combined detection of FLC,CEA,and CYFRA21-1 offers the best diagnostic efficacy.
serum free light chainlung cancerdiagnostic valuecarcinoembryonic antigencytokeratin fragment antigen 21-1
NETL
NSTL
万方数据
