CYFRA21-1、CEA和Ki67在非小细胞肺癌中的表达及预后因素分析  

Expression and prognostic factors analysis of CYFRA21-1,CEA,and Ki67 in non-small cell lung cancer

作　　者：潘剑云 黄贻恩 洪淑君 方韶韩 刘经纬 陈伟强 潘高涧 姜杰[2] 耿国军[1,2,3] PAN Jianyun;HUANG Yien;HONG Shujun;FANG Shaohan;LIU Jingwei;CHEN Weiqiang;PAN Gaojian;JIANG Jie;GENG Guojun(Department of Thoracic Surgery,The First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen,361003,Fujian,P.R.China;Department of Thoracic Surgery,The First Affiliated Hospital of Xiamen University,Xiamen,361003,Fujian,P.R.China;The Third Clinical Medical College,Fujian Medical University,Fuzhou,350122,P.R.China)

机构地区：[1]厦门大学附属第一医院胸外科厦门大学医学院,福建厦门361003 [2]厦门大学附属第一医院胸外科,福建厦门361003 [3]福建医科大学第三临床医学院,福州350122

出　　处：《中国胸心血管外科临床杂志》2024年第5期682-688,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：福建省自然科学基金(2020J01122609;2021J05284)。

摘　　要：目的探讨术前细胞角蛋白19的可溶性片段(CYFRA21-1)、癌胚抗原(CEA)联合术后细胞核增殖相关抗原Ki67检测对非小细胞肺癌患者预后评估的价值。方法收集2017年于厦门大学附属第一医院胸外科就诊的非小细胞肺癌患者的临床资料。CYFRA21-1>3.39 ng/mL或CEA>5 ng/mL定义为阳性。绘制Ki67表达水平的受试者工作特征(ROC)曲线,曲线下面积(AUC)最大时为Ki67表达水平的截断值,Ki67表达水平大于其截断值定义为阳性。利用Cox回归分析确定非小细胞肺癌患者不良预后的独立危险因素。结果纳入患者248例,其中男125例、女123例,手术时中位年龄61(30~81)岁。单因素分析表明,CYFRA21-1阳性、Ki67高表达、CEA阳性、患者手术时年龄≥60岁、有淋巴结转移、肿瘤最大直径>3 cm、TNM分期Ⅲ期与非小细胞肺癌患者不良预后相关(P均<0.05)。联合检测术前肿瘤标志物与术后Ki67时,全阴性时患者预后均最好,全阳性时患者预后均最差。Cox回归多因素分析显示,CEA阳性+CYFRA21-1阳性+Ki67高表达是非小细胞肺癌患者不良预后的独立危险因素(P<0.05)。结论联合检测术前血清CYFRA21-1、CEA与术后Ki67对评估非小细胞肺癌患者预后有重要价值。Objective To explore the value of preoperative detection of soluble fragments of cytokeratin-19(CYFRA21-1),carcinoembryonic antigen(CEA),and postoperative detection of nuclear proliferation associated antigen Ki67 in prognostic evaluation of non-small cell lung cancer patients.Methods The clinicopathological data and followup results of patients with non-small cell lung cancer treated in the Department of Thoracic Surgery of the First Affiliated Hospital of Xiamen University in 2017 were collected.CYFRA21-1>3.39 ng/mL was defined as positive,and CEA>5 ng/mL was defined as positive.The receiver operating characteristic curve(ROC curve)of Ki67 expression level was drawn.The maximum area under the curve(AUC)was the cutoff value of Ki67 expression level,and the Ki67 expression level greater than its cutoff value was defined as positive.Cox regression analysis was used to determine the independent risk factors for poor prognosis in patients with non-small cell lung cancer.Results Finally 248 patients were collected,including 125 males and 123 females,with a median age of 61 years(ranging from 30 to 81 years)at the time of surgery.Univariate analysis showed that positive CYFRA21-1,high expression of Ki67,positive CEA,age≥60 years at operation,distant metastasis,lymph node metastasis,maximum tumor diameter>3 cm,and TNM stageⅢwere associated with poor prognosis in patients with non-small cell lung cancer.When combined detection of preoperative tumor markers and postoperative Ki67,the prognosis of all negative patients was the best,and that of all positive patients was the worst.Cox regression analysis showed that positive CEA+positive CYFRA21-1+high expression of Ki67 was an independent risk factor for poor prognosis in patients with non-small cell lung cancer(P<0.05).Conclusion The combined detection of preoperative serum CYFRA21-1,CEA,and postoperative Ki67 has important value in evaluating the prognosis of nonsmall cell lung cancer patients.

关 键 词：非小细胞肺癌 肿瘤标志物 KI67 预后 

分 类 号：R734.2[医药卫生—肿瘤]