血清细胞角蛋白19片段21-1、E26转录因子-1联合^(18)F-FDG PET/CT对胃癌术后复发的诊断价值  

Diagnostic Value of Serum Cytokeratin 19 Fragment 21-1,E26 Transformation Specific-1 Combined with ^(18)F-FDG PET/CT for Postoperative Recurrence of Gastric Cancer

作　　者：孔宪诚[1] 黄建平[1] 阎良[1] 汤雪峰[1] KONG Xiancheng;HUANG Jianping;YAN Liang;TANG Xuefeng(Department of General Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院普外科,上海201203

出　　处：《医学综述》2021年第23期4764-4769,共6页Medical Recapitulate

基　　金：上海市进一步加快中医药事业发展三年行动计划(2018年—2020年)项目[ZY(2018-2020)-ZYBZ-07]。

摘　　要：目的探讨血清细胞角蛋白19片段抗原21-1(CYFRA21-1)、E26转录因子-1(Ets-1)检测联合^(18)F-氟代脱氧葡萄糖(^(18)F-FDG)正电子发射断层显像/CT(PET/CT)对胃癌术后复发的诊断价值。方法选取2018年1月至2020年1月在上海中医药大学附属曙光医院普外科行手术切除治疗的178例胃癌患者为研究对象,术后随访截止时间2021年2月,无死亡病例。根据再次手术后病理检查结合临床随访结果分为术后复发组(31例)和术后未复发组(147例)。分别采用电化学发光法、化学发光酶联免疫分析法检测所有受试者血清CYFRA21-1、Ets-1水平,并进行^(18)F-FDG PET/CT检查,测定半定量参数原发灶最大标准摄取值(SUV_(max)),并绘制受试者工作特征曲线(ROC曲线)评估血清CYFRA21-1、Ets-1水平、SUV_(max)指标单独及三者联合对胃癌术后复发的诊断价值。结果术后复发组血清CYFRA21-1、Ets-1水平、SUV_(max)值均高于术后未复发组[(5.79±0.61)μg/L比(2.68±0.29)μg/L、(6.16±0.63)μg/L比(2.78±0.31)μg/L、(3.81±0.41)比(1.38±0.15)](P<0.01)。术后复发患者血清CYFRA21-1、Ets-1水平、SUV_(max)值最佳截断点分别为3.45μg/L、3.51μg/L、2.56,三项指标单独检测诊断胃癌术后复发的ROC曲线下面积分别为0.713(95%CI 0.674~0.742)、0.709(95%CI 0.617~0.737)、0.715(95%CI 0.676~0.749),灵敏度分别为77.42%、74.19%、80.65%,特异度分别为68.71%、66.67%、69.39%,准确度分别为70.22%、67.98%、71.35%;三项指标联合诊断胃癌术后复发的ROC曲线下面积为0.778(95%CI 0.724~0.846),灵敏度为67.74%、特异度为85.03%、准确度为82.02%,三项联合检测诊断胃癌术后复发的特异度、准确度高于单独诊断(P<0.05)。结论血清CYFRA21-1、Ets-1水平及SUV_(max)值联合诊断胃癌术后复发较单一指标诊断效能更高。Objective To investigate the value of serum cytokeratin 19 fragment antigen 21-1(CYFRA21-1)and E26 transcription factor-1(Ets-1)combined with ^(18)F-fluorodeoxyglucose(^(18)F-FDG)positron emission tomography/CT(PET/CT)in the diagnosis of postoperative recurrence of gastric cancer.Methods A total of 178 patients with gastric cancer who underwent surgical resection in the Department of General Surgery of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from Jan.2018 to Jan.2020 were included.Till the end of the postoperative follow-up of Feb.2021,there were no deaths.According to the pathological examination after reoperation and clinical follow-up results,they were divided into a postoperative recurrence group(31 cases)and a postoperative non-recurrence group(147 cases).The levels of serum CYFRA21-1 and Ets-1 in all the patients were detected by electrochemiluminescence and chemiluminescence enzyme-linked immunosorbent assay,and the ^(18)F-FDG PET/CT was performed to measure the semi-quantitative parameter of maximum standard uptake value(SUV_(max))of primary focus,and the receiver operating characteristic(ROC)curve was drawn to evaluate the serum CYFRA21-1 level,Ets-1 level,and SUV_(max) index alone and in combination in the diagnosis of postoperative recurrence of gastric cancer.Results The levels of serum CYFRA21-1,Ets-1 and SUV_(max) in the postoperative recurrence group were higher than those in the non-recurrence group[(5.79±0.61)μg/L vs(2.68±0.29)μg/L,(6.16±0.63)μg/L vs(2.78±0.31)μg/L,(3.81±0.41)vs(1.38±0.15)](P<0.01).The best cutoff points of serum CYFRA21-1,Ets-1 and SUV_(max) were 3.45μg/L,3.51μg/L,and 2.56 respectively,and the areas under the ROC curve of the subjects with postoperative recurrence of gastric cancer were 0.713(95%CI 0.674-0.742),0.709(95%CI 0.617-0.737)and 0.715(95%CI 0.676-0.749),respectively;the sensitivity was 77.42%,74.19%and 80.65%respectively;the specificity was 68.71%,66.67%and 69.39%respectively;and the accuracy was 70.22%,67.98%and

关 键 词：胃癌 血清细胞角蛋白19片段21-1 E26转录因子-1 ^(18)F-氟代脱氧葡萄糖正电子发射断层显像 

分 类 号：R735.2[医药卫生—肿瘤]