肿瘤标志物在肺癌诊断中的作用  

The effect of tumor markers in diagnosis of lung cancer

作　　者：李鉴[1] 张德超[1] 汪良骏[1] 张大为[1] 张汝刚[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院胸外科,北京100021

出　　处：《癌症进展》2003年第4期222-225,共4页Oncology Progress

摘　　要：目的 探索肿瘤标志物在肺癌鉴别诊断和区分肺癌各种组织学类型上的作用。方法 本组通过免疫分析试剂盒,检测180例胸部疾病患者血清中的CA125、CA242、NSE、CYFRA 21-1四项肿瘤标志物。根据组织学诊断、肿瘤分化程度和淋巴结转移指标,针对肺癌进行分组比较。结果 ①肺小细胞未分化癌NSE、CA125值较非肺癌疾病组高(P<0.05),也较本组其他病例高(P<0.05)。肺鳞癌CYFRA 21-1值较食管鳞癌高(P<0.05)。在CA242项中,各组间统计学上均无显著性差异(P>0.05);②未分化组NSE、CA125值较分化组高(P<0.05)。CYFRA 21-1在有淋巴结转移组较高(P=0.056);③检测肺小细胞未分化癌,特异度为95％时,NSE正常值为<50U/ml,灵敏度为35.5％;CA125正常值为<50U/ml,灵敏度为30％。检测肺鳞癌,特异度为95％时,CYFRA 21-1正常值为<20U/ml,灵敏度为20.6％。结论 肿瘤标志物对诊断有一定帮助,对预后可能有一定影响,在鉴别肺癌组织学类型上的作用可能较小。相比之下,NSE对肺小细胞未分化癌最敏感,CA125次之;CY-FRA 21-1对肺鳞癌较敏感;CA242对鉴别诊断可能无效。This study was designed to evaluate the utility of serum tumor markers in differential diagnosis and differentiating various histological types of lung cancer. Methods Serum levels of NSE、CYFRA 21-1、CA125、CA242 were obtained respectively by means of immunoradiometric assay (IRMA) in 180 cases with thoracic disease including 113 cases of lung cancer, 67cases non-neoplastic pulmonary disease (NNPD). The following parameters were considered: histological types of lung cancer, histological differentiation, and lymph nodes metastasis. Result ①The mean value of serum NSE and CA125 in SCLC (28.39U/ml; 26.12U/ml) was significantly higher than in NNPD (18.25U/ml; 10.30 U/ml) (P < 0.05); The mean value of serum NSE, CA125 in SCLC (28.39 U/ml; 26.13U/ml) was significantly higher than in the other cases of our series (17.12 U/ml; 14.11 U/ml) ( P < 0.05). The mean value of serum CYFRA 21 - 1 in lung squamous carcinoma (8.91 U/ml) was significantly higher than in esophagus squamous carcinoma (3.92 U/ml) (P < 0.05);②The mean value of serum NSE and CA125 in undifferentiation (27.55 U/ml; 26.13 U/ml) was significantly higher than in differentiation group (18.90 U/ml; 14.11 U/ml) (P<0.05). There was significantly different tend between the mean values of serum CYFRA 21 - 1 in lymph nodes metastasis (7.54 U/ml) and in no lymph nodes metastasis (2.98 U/ml) ( P = 0.056) ;③A cut - off value was 50U/ml for NSE in SCLC, sensitivity was 35.5% ; a cut - off value was 50U/ml for CA125 in SCLC, sensitivity was 30.0% ; a cut - off value was 20U/ml in lung squamous carcinoma for CYFRA 21 - 1, Sensitivity was 20.6% , while a corresponding 95 % specificity for the other cases of our series. Conclusion Tumor markers may influence prognosis and were useful for diagnosis. However, they do not play an important role in differentiating various histological types of lung cancer. By comparison, NSE was most sensitive to SCLC, CA125 was next; CYFRA 21-1 was sensitive to lung squamous carcinoma. CA242 may be no useful in diagnosis of lung ca

关 键 词：肿瘤标志物 鉴别诊断 组织学分类 

分 类 号：R734.2[医药卫生—肿瘤]