常用血清肿瘤标志物在可手术肺癌患者预后中的价值

李少雷; 马媛媛; 雄英; 张善渊; 黄淼; 杨跃

doi:10.3971/j.issn.1000-8578.2018.17.0854

常用血清肿瘤标志物在可手术肺癌患者预后中的价值

Role of Serum Tumor Markers in Prognosis of Operable Non-small Cell Lung Cancer Patients

摘要

摘要:
目的探讨血清CEA、CA125、CA199、NSE、CYFRA21-1和SCC-Ag水平在评估非小细胞肺癌根治手术后的预后价值，以期合理选择术前的检验指标。
方法收集1 851例行肺癌根治手术的患者术前血清肿瘤标志物的检验值、临床病理和随访信息，进行差异及生存分析。
结果 CEA、CA125、CA199、CYFRA21-1和SCC-Ag的阳性率在不同病理分期中差异有统计学意义（P < 0.001），Ⅱ和Ⅲ期的患者阳性率明显高于Ⅰ期患者，而NSE差异无统计学意义（P=0.743）。CEA、CA125、CA199、CYFRA21-1阴性组患者的生存率显著高于阳性组（P < 0.05）。NSE阴性的患者远期生存率劣于阳性组患者（P=0.033）。SCC-Ag阳性与阴性患者的远期生存率差异无统计学意义（P=0.072）。Cox回归比例风险模型分析发现CEA（HR=1.572, 95%CI: 1.117~2.214, P=0.010）、CA125（HR=2.464, 95%CI: 1.610~3.772, P < 0.001）和CYFRA21-1（HR=1.445, 95%CI: 1.044~2.000, P=0.027）是评价非小细胞肺癌手术预后的独立危险因素。
结论 CEA、CA125和CYFRA21-1在评价非小细胞肺癌手术预后方面有良好的应用价值，而CA199、NSE和SCC-Ag等指标价值有限。

Abstract:
Objective To evaluate the prognostic value of CEA, CA125, CA199, NSE, CYFRA21-1 and SCC-Ag as serum tumor markers on the diagnosis of operable non-small cell lung cancer(NSCLC) after radical operation.
Methods We reviewed 1851 consecutive NSCLC patients who underwent radical resection from January 2005 to December 2014. We used analysis of variance (ANOVA) to analyze the associations between tumor markers and pathological stage. Survival probability was estimated by the Kaplan-Meier method. Cox proportional hazards regression was used to identify independent prognostic factors.
Results The positive rates of CEA, CA125, CA199, CYFRA21-1 and SCC-Ag in stage Ⅱ and Ⅲ NSCLC were higher than those in stageⅠ(P < 0.001), but there was not significant difference among different stages for NSE (P=0.743). The overall survival in negative group of CEA, CA125, CA199 and CYFRA21-1 were better than those in positive group respectively (P < 0.05), but the survival in positive group of NSE was better than that in negative group (P=0.033). SCC-Ag negative group had longer survival time than SCC-Ag positive group, without statistically significant difference (P=0.072). CEA (HR=1.572, 95%CI: 1.117-2.214, P=0.010), CA125(HR=2.464, 95%CI: 1.610-3.772, P < 0.001), CYFRA21-1 (HR=1.445, 95%CI: 1.044-2.000, P=0.027) were detected to be independent risk factors for the prognosis of NSCLC patients.
Conclusion CEA, CA125 and CYFRA21-1 play an important role prior to CA199, NSE and SCC-Ag in predicting severity and prognosis of NSCLC patients.

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