摘要
目的 探讨血清肿瘤标志物检测对肺腺癌的诊断价值及术后复发的预测价值.方法 选取2018年12月至2020年12月河北省沧州中西医结合医院收治的100例肺腺癌患者(建模组)和100例肺部良性疾病患者(对照组)作为研究对象,另选取2016年12月至2017年12月收治的50例肺腺癌患者作为验证组,比较建模组和对照组患者血清糖类抗原125(CA125)、癌胚抗原(CEA)、细胞角蛋白21片段(CYFRA21-1)、糖类抗原19-9(CA19-9)和鳞状上皮细胞癌抗原(SCC-Ag)水平,采用受试者工作特征(ROC)曲线评估CA125、CEA、CYFRA21-1、CA19-9、SCC-Ag单独及联合检测对肺腺癌的诊断价值;单、多因素分析影响肺腺癌患者术后复发的危险因素;采用R软件构建预测肺腺癌患者术后复发的列线图模型,并构建危险分层系统.结果 建模组患者CA125、SCC-Ag、CEA、CYFRA21-1、CA19-9 水平均明显高于对照组(均 P＜0.05).ROC 曲线显示 CA125、CEA、CYFRA21-1、CA19-9、SCC-Ag联合检测对肺腺癌具有较高的诊断价值,其曲线下面积(AUC)为0.903(95％CI:0.865～0.954);CEA、CA125、CA19-9、CYFRA21-1水平升高是影响肺腺癌患者术后复发的独立危险因素(均P＜0.05).通过危险分层将患者分为极低风险组(总分＜56分)、低风险组(56分≤总分＜132分)、中风险组(132分≤总分＜186分)和高风险组(总分≥186分),生存曲线结果表明,不同危险分层系统患者术后复发率间差异有统计学意义(P＜0.05).结论 CA125、CEA、CYFRA21-1、CA19-9、SCC-Ag联合检测对肺腺癌具有较高的诊断价值,其中CA125、CEA、CYFRA21-1、CA19-9对患者术后复发具有一定的预测价值.
Abstract
Objective To explore the diagnostic value of serum tumor marker detection for lung adenocarcinoma and its predictive value for postoperative recurrence.Methods A total of 100 lung adenocarcinoma patients(modeling group)and 100 benign lung disease patients(control group)admitted to the Cangzhou Hospital of Integrated Traditional and Western Medicine from December 2018 to December 2020 were selected as the research subjects.In addition,50 lung adenocarcinoma patients admitted from December 2016 to December 2017 were selected as the validation group.The serum carbohydrate antigen 125(CA125)and carcinoembryonic antigen(CEA)levels of the modeling group and the control group were compared Levels of cytokeratin 21 fragment(CYFRA21-1),carbohydrate antigen 19-9(CA19-9),and squamous cell carcinoma antigen(SCC-Ag).The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of CA125,CEA,CYFRA21-1,CA19-9,and SCC-Ag alone and in combination for lung adenocarcinoma;Single and multiple factor analyses were conducted to identify the risk factors for postoperative recurrence in lung adenocarcinoma patients;A column chart model for predicting postoperative recurrence in lung adenocarcinoma patients was constructed using R software,and a risk stratification system was constructed.Results The average water levels of CA125,SCC-Ag,CEA,CYFRA21-1,and CA19-9 in the modeling group were significantly higher than those in the control group(all P＜0.05).The ROC curve showed that the combined detection of CA125,CEA,CYFRA21-1,CA19-9,and SCC-Ag had high diagnostic value for lung adenocarcinoma,with an area under the curve(AUC)of 0.903(95％CI:0.865-0.954);Elevated levels of CEA,CA125,CA19-9,and CYFRA21-1 were independent risk factors for postoperative recurrence in lung adenocarcinoma patients(all P＜0.05).Patients were divided into extremely low-risk group(total score＜56 points),low-risk group(56 points≤total score＜132 points),medium risk group(132 points ≤ total score＜186 points),and high-risk group(total score ≥186 points)through risk stratification.The survival curve results showed that there was a statistically significant difference in postoperative recurrence rate among patients with different risk stratification systems(P＜0.05).Conclusions The combined detection of CA125,CEA,CYFRA21-1,CA19-9,and SCC-Ag has high diagnostic value for lung adenocarcinoma.Among them,CA125,CEA,CYFRA21-1,and CA19-9 have certain predictive value for postoperative recurrence in patients.
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