Objective To explore the clinical value of combined detection of serum tumor markers carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA 21-kloc-0/), neuron-specific enolase (NSE) and squamous cell carcinoma-associated antigen (SCCA) in the diagnosis of lung cancer. Methods Serum CEA, CYFRA2 1- 1, NSE and SCCA were detected by microparticle chemiluminescence method in 68 patients with lung cancer and 65 healthy controls, and the sensitivity, specificity and accuracy of tumor markers in detecting lung cancer alone or in combination were compared. Results The contents of serum CEA, CYFRA2 1- 1, NSE and SCCA in lung cancer group were significantly higher than those in control group (P
Lung cancer; Tumor markers; Joint detection
?
At present, the incidence and mortality of lung cancer are the highest in China [1]. Early detection and treatment of lung cancer is of great clinical significance. Serum tumor markers can not only be used for tumor diagnosis, but also have important clinical value for tumor staging, curative effect and prognosis judgment [2]. However, the single detection of tumor markers has limitations. By detecting the expression of CEA, CYFRA2 1- 1, NSE and SCCA in serum of patients with lung cancer, the application value of tumor markers in the diagnosis of lung cancer and the significance of joint detection were discussed. The report is as follows.
1 data and methods
1. 1 General data Sixty-eight patients with lung cancer hospitalized in our hospital from July 2065438 to February 2065438 were selected as the lung cancer group, including 39 males and 29 females, with an average age of (67.214. Small cell lung cancer 17 cases, and 65 healthy people as control group, including 37 males and 28 females, with an average age of (67.615.1) years. There was no significant difference in general data between the two groups (P & gt0.05), which was comparable.
1.2 detection method 4 ml of fasting venous blood was collected in the morning, and serum was separated in time. The levels of CEA, CYFRA2 1- 1, NSE and SCCA were detected by microparticle chemiluminescence method with Shenzhen New Industry PLUS200 instrument and supporting reagents. Strictly follow the standard operating procedures and reagent instructions of the instrument, and conduct indoor quality control again on the day of testing. The normal reference ranges are CEA 0 ~ 5 ng/ml, CYFRA 21-kloc-0/0 ~ 7 ng/ml, NSE 0 ~ 10 ng/ml, SCCA 0 ~ 2.5 ng/L, respectively.
1.3 positive standard is positive when the single detection result is greater than the upper limit of the normal reference interval, and it is positive when one of the four tumor markers is positive by combined detection.
1.4 statistical methods SPSS 13.0 statistical software was used for data analysis. The measurement data were expressed by the mean standard deviation (X-S), and t test was used for comparison between groups. Counting data were expressed as percentage (%), and χ2 test was used for comparison between groups. P < 0.05 was statistically significant. The sensitivity, specificity and accuracy of tumor markers in the diagnosis of lung cancer were calculated according to the standard formula. Sensitivity = true positive/(true positive+false negative) ×100%; Specificity = true negative/(true negative+false positive) ×100%; Accuracy = (true positive+true negative)/(true positive+false positive+true negative+false negative) × 100%.
Two results
2. Comparison of four serum tumor markers (1) The contents of CEA, CYFRA 21-kloc-0/,NSE and SCCA in lung cancer group were significantly higher than those in control group, and the difference was statistically significant (P
2.2 Comparison of the positive rates of four tumor markers in serum of patients with different histopathological types of lung cancer; The positive rate of CEA in lung adenocarcinoma was higher than that in squamous cell carcinoma and small cell lung cancer (P
2.3 Sensitivity, specificity and accuracy of four tumor markers in the diagnosis of lung cancer. When four tumor markers are used alone in the diagnosis of lung cancer, the highest sensitivity is CYFRA2 1- 1(56%) and the lowest is CEA (29%). After the combined detection of four indexes, the sensitivity can reach 8 1%, and the combined detection of four tumor markers. 0.05)。 After combined detection, the specificity decreased slightly (p = ""& gt0.05). See table 3.
3 discussion
Lung cancer is a malignant tumor. In recent years, although great progress has been made in clinical tumor diagnosis and treatment, the mortality rate of lung cancer is still high [3]. Besides imaging, cytology and histopathology, the detection of tumor markers is also the main method for the diagnosis of lung cancer. Tumor markers mainly refer to tumor-related substances that can be detected in blood, body fluids and tissues. When these substances reach a certain level, they can reveal the existence of some tumors. Tumor markers can be detected by serological methods before obvious imaging changes of tumors, which provides a new way for early diagnosis and treatment of tumors. Because of the diversity of lung cancer histopathology, the heterogeneity of cells in the same pathological tissue and the complexity of tumor biological behavior, the joint detection of multiple tumor markers is an effective means to improve the detection rate of lung cancer [4].
CEA is a non-organ specific tumor-associated antigen and one of the earliest tumor markers, which plays a very important role in the occurrence and metastasis of tumors [5]. In tumor state, cancer cells secrete CEA into blood and lymphatic circulation, so the serum CEA content of tumor patients can be increased to varying degrees. This study shows that the serum CEA level of lung cancer patients is significantly higher than that of healthy control group, and the positive rate in lung adenocarcinoma is 75%, while the positive rate in squamous cell carcinoma and small cell lung cancer is lower, 26% and 24% respectively, so CEA can be used as one of the auxiliary diagnostic indexes of lung adenocarcinoma.
NSE is an isozyme of glycolytic enzyme and enolase, which exists in malignant tumors of central and peripheral nerve tissues and neuroectoderm origin. Small cell lung cancer is a tumor of neuroendocrine origin. As a serum tumor marker of small cell lung cancer, NSE has high sensitivity and specificity [6]. The results of this study showed that the positive rates of NSE in small cell lung cancer were 765,438+0%, and the positive rates in squamous cell carcinoma and adenocarcinoma were lower, 22% and 25% respectively. It is also proved that NSE has low diagnostic significance for squamous cell carcinoma and adenocarcinoma, and can be used as one of the auxiliary diagnostic indexes for small cell lung cancer.
CYFRA2 1- 1 is a fragment of cytokeratin 19, which is a scaffold protein of normal and malignant epithelial cells, mainly distributed in monolayer epithelial cells, and its content is obviously increased in epithelial tissue-derived tumor tissues, so it is a sensitive tumor marker of non-small cell lung cancer [7]. In this study, it was observed that the positive rate of CYFRA2 1- 1 was 78% in lung squamous cell carcinoma, followed by lung adenocarcinoma, with a positive rate of 54%, and the positive rate in small cell lung cancer was very low, which was consistent with the literature reports.
SCCA is a squamous cell carcinoma-associated antigen, which is a glycoprotein fragment purified from tumor-associated antigen TA4 by monoclonal technique. In this study, it was observed that the positive rate of SCCA was 67% in lung squamous cell carcinoma, and it was lower in adenocarcinoma and small cell carcinoma.
The results of this study showed that the serum levels of four tumor markers in patients with lung cancer were significantly higher than those in healthy controls, and the difference was statistically significant (P < 0.05), indicating that the detection of these four tumor markers has certain application value in the clinical diagnosis of lung cancer. However, the positive rate of single test is not high, CEA is only higher in lung adenocarcinoma, NSE can be used as one of the auxiliary diagnostic indexes of small cell lung cancer, CYFRA2 1- 1 is higher in lung squamous cell carcinoma, and SCCA is a specific marker of squamous cell carcinoma. However, the combined detection of these four tumor markers has a high Levin rate in all tissue types of lung cancer. The study also shows that they have certain specificity in clinical application as a single diagnostic index, but their sensitivity and accuracy are not ideal. After combined detection, the sensitivity and accuracy are improved, which is beneficial to the early diagnosis and treatment of lung cancer.
refer to
[1], Ren,, etc. Estimation and prediction of incidence and death of malignant tumor in China in 2008. China Journal of Epidemiology, 2012,33 (1): 57-61.
Hu Wei, Chen Hong, Shi Zhong, et al. Application of surface plasmon resonance imaging double signal amplification technique in immunoassay of tumor markers. Anal Biochemistry, 2014,4 (453):16-21.
Chen Jianzhong, Gu Lijiang. Clinical significance of serum CEA, NSE, CA 19-9 and VEGF in patients with lung cancer. China Modern Doctor, 20 1 1, 49 (8): 28-29.
[5]Canbay E, Ishibashi H, Sako S, et al. Preoperative carcinoembryonic antigen level can predict the prognosis of patients with peritoneal pseudomyxoma after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Surgery, 2013,37 (6):127/kloc-0.
Puyol JL, bogel JM, Gorenel J et al. Neuron-specific enolase and prognosis of non-small cell lung cancer: A prospective study of 62 1 patients. Lung cancer, 200 1, 3 1(3):22 1-228.
;