SCC-Ag在宫颈癌中应用的研究进展

肿瘤标志物对评估肿瘤反应和监测肿瘤复发有着重要作用。鳞状细胞癌抗原（squamous cell carcinoma antigen,SCC-Ag）在肿瘤的诊断、分期、预后、随访等方面具有重要的临床意义,尤其在宫颈鳞状细胞癌（cervical squamous cell carcinoma,CSCC）中作用更重要,因为CSCC是宫颈癌最常见病理类型。SCC-Ag在CSCC中具有较好的辅助诊断、疗效监测、指导预后的作用,但是目前在CSCC诊断、分期、预后、随访方面并无具体SCC-Ag临床诊断临界值。本文就SCC-Ag的生物学特点及近年有关SCC-Ag在CSCC中的研究进展作一简要综述。     

血浆鳞状细胞癌抗原与宫颈癌期别和预后相关性

目的 探讨宫颈癌患者血浆鳞状细胞癌抗原(SCC-Ag)阳性率与宫颈癌期别及预后的相关性.方法 选择我院2006-2009年宫颈癌患者164例,回顾性分析其血浆SCC-Ag阳性率与宫颈癌的期别、病理类型及治疗前后关系.结果 宫颈鳞癌患者血浆SCC-Ag阳性率明显升高,期别越晚SCC-Ag阳性率越高,术后及治疗后较术前、治疗前阳性率明显下降.宫颈腺癌SCC-Ag阳性率无明显升高.结论 血浆SCC-Ag阳性率与宫颈鳞癌的期别呈正相关;血浆SCC-Ag水平可作为宫颈鳞癌病变程度及治疗监测的指标.     

Detection of cervical cancer recurrence during follow-up: A multivariable comparison of 9 frequently investigated serum biomarkers

Objective

To assess the diagnostic accuracy and model the optimal combination of commonly studied serum biomarkers aimed at identifying recurrence in cervical cancer patients.

Methods

From a systematic literature search, nine biomarkers (CA-15.3, CA-125, CEA, CYFRA 21-1, hsCRP, IL-6, SCC-Ag, TNF-α and VEGF) were selected for a serum analysis. Samples were derived from a historical cervical cancer cohort. Subjects with serum samples stored in a biobank were included when quality criteria were met, and one sample preceding and at least one following primary treatment were available. In case of recurrence, two additional post-recurrence samples were analyzed. Biomarker serum levels were quantified by enzyme linked or chemiluminescence microparticle immunoassays. Logistic regression and receiver operating curve analysis were employed for selection, modeling and comparison on the diagnostic accuracy of the tested biomarkers.

Results

205 samples were analyzed from 75 subjects, of whom 19 (25.3%) had a recurrence. The area under the curve (AUC) of CA-15.3, CA-125, CEA, CYFRA 21-1, IL-6, TNF-α and VEGF were all < 0.750. Only SCC-Ag and hsCRP were included in the final model with an AUC of 0.822 (95% CI: 0.744–0.900) and 0.831 (95% CI: 0.758–0.905) respectively. Combined AUC was 0.870 (95% CI: 0.805–0.935). Rises in SCC-Ag and hsCRP significantly increased the odds for recurrence. Each ng/ml of SCC-Ag increase, related to an odds ratio (OR) of 1.117 (95% CI: 1.039–1.200). Comparably, the OR for hsCRP (in mg/ml) was 1.025 (95% CI: 1.012–1.038).

Conclusion

Combined testing of SCC-Ag and hsCRP yields the highest detection rate of disease recurrence during cervical cancer follow-up.     

宫颈及其他鳞癌SCC-Ag、Survivin研究现状

宫颈癌是目前全球女性第三大常见恶性肿瘤,有较高的发病率和死亡率,高危型HPV(HR-HPV)持续感染为其主要致病因素。鳞状细胞癌（squamous cell carcinoma,SCC）是宫颈癌最主要的病理类型,也常见于皮肤、头颈、食管、肺等,严重威胁人类健康及生命。作为一种新型手段,生物标记物及靶向治疗对于鳞癌的诊治具有十分重要的意义。血清SCC-Ag单独检测目前多用于鳞癌的辅助诊断,联合应用诸如HPV-DNA、磁共振技成像（magnetic resonance imaging,MRI）等检查手段,可提高鳞癌诊断的敏感性与特异性,并有助于其致病机制的研究;生存素在鳞癌中的作用近年来正被广泛研究,尤其于鳞癌发病早期凸显其在诊断中的独特应用价值,更进一步研究展示出了其在靶向治疗中的潜在应用前景。     

伊立替康联合顺铂与紫杉醇联合顺铂治疗宫颈癌的临床疗效分析

目的 比较伊立替康联合顺铂与紫杉醇联合顺铂治疗宫颈癌患者的临床疗效.方法 选择2012年1月至2015年12月在江汉大学附属医院进行中晚期宫颈癌治疗的患者76例,随机分为观察组和对照组,各38例.对照组使用紫杉醇联合顺铂(TP)方案进行治疗,观察组使用伊立替康联合顺铂(IP)方案进行治疗.观察两组患者临床疗效、治疗前后血清SCC-Ag、CD133水平变化以及不良反应发生情况.结果 观察组患者总有效率为89.47％,对照组为68.42％,观察组患者治疗后总有效率明显高于对照组,且具有统计学差异(x2=3.879,P＜0.05).肿瘤直径治疗前两组无明显差异(t=0.420,P＞0.05),治疗后均有所减小,而观察组减少的更为明显(t=3.442,P＜0.05).两组患者治疗前血清SCC-Ag、CD133水平无明显差异,治疗后观察组患者血清SCC-Ag水平(t=10.690,P＜0.05)和CD133阳性率明显低于对照组(x2=4.375,P＜0.05).观察组患者骨髓抑制、消化道反应、脱发、肝肾功能损害以及外周神经毒性等不良反应发生率均低于对照组,具有统计学差异(x2值分别为6.480、5.330、5.510、5.050、5.680,均P＜0.05).结论 伊立替康联合顺铂化疗对中晚期宫颈癌患者具有良好的临床疗效,能够显著降低患者血清SCC-Ag、CD133水平,且不良反应小,安全可靠.     

联合检测血清中4种肿瘤标志物对肺癌的诊断价值

目的探讨血清癌胚抗原(CEA)、细胞角质蛋白(Cyfra21‐1)、鳞状上皮细胞癌抗原(SCC‐Ag)和神经烯醇化酶(NSE)对肺癌诊断的价值.方法采集65例肺癌患者(其中腺癌28例、鳞癌25例、小细胞肺癌12例)和40例肺部良性病变患者血清标本,采用电化学发光免疫法检测.结果CEA 、Cyfra21‐1、SCC‐Ag 和 NSE 在肺癌组的灵敏度分别为46.2%、40.0%、43.1%和46.2%,高于肺部良性病变组(P <0.05).Ⅲ期、Ⅳ期肺癌 CEA 、Cy‐fra21‐1、SCC‐Ag 及 NSE 的平均含量显著高于Ⅱ期肺癌(P<0.01).将4项联合检验,对肺癌诊断的灵敏度上升到75.5%,高于4项单独检测时的灵敏度(P<0.01).结论将 CEA 、Cyfra21‐1、SCC‐Ag 、NSE 4项联合检测可提高肺癌的诊断率,有一定的临床价值.     

Serum p53 antibody as a predictor of early recurrence in patients with postoperative esophageal squamous cell carcinoma

It is reported that surveillance of serum p53 antibody (Ab) is a useful marker in detecting esophageal squamous cell carcinoma (ESCC). But there is little reported about prognostic significance of serum p53-Ab in postoperative patients with ESCC. The aim of this study is to evaluate the significance of preoperative serum p53-Ab as a marker of early recurrence after curative resection for ESCC. Enzyme-linked immunosorvent assay (ELISA) was used to analyze serum p53-Ab before treatment in 44 patients with ESCC. Carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) were examined by immunoradiometric assay. The patients who were strongly positive and positive in serum p53-Ab were more likely to have early recurrence after curative resection than seronegative patients. There were no significant correlations between CEA, SCC-Ag positivity and early recurrence. We found that serum p53-Ab was useful to predict a risk of early recurrence after curative surgical resection for ESCC.     

肺癌患者血清 CEA、SCC-Ag、CYFRA21-1及 NSE 与三种肺癌病理分型间的相关性研究

目的：探讨肺癌患者血清肿瘤标志物癌胚抗原（ CEA）、鳞状细胞癌抗原（ SCC-Ag）、细胞角蛋白19片段（ CYFRA21-1）和神经元特异性烯醇化酶（ NSE）与三种肺癌病理分型间的相关性及其临床意义。方法通过统计学方法对56例确诊肺癌患者治疗前的血清癌胚抗原（ CEA）、鳞状细胞癌抗原（ SCC-Ag）、细胞角蛋白19片段（ CYFRA21-1）和神经元特异性烯醇化酶（ NSE）阳性率结合病理分型进行分析。结果癌胚抗原（ CEA）在腺癌组阳性率为65骀．00％,明显高于鳞癌和小细胞肺癌组（ P ＜0．01）;鳞状细胞癌抗原（SCC-Ag）、细胞角蛋白19片段（CYFRA21-1）在鳞癌组阳性率分别为47．37％、57．89％,明显高于腺癌组和小细胞肺癌组（ P ＜0．01）;神经元特异性烯醇化酶（ NSE）在小细胞癌组阳性率为76．47％,明显高于鳞癌和腺癌组（ P ＜0．01）。结论癌胚抗原（ CEA ）、鳞状细胞癌抗原（ SCC-Ag）和细胞角蛋白19片段（ CYFRA21-1）是较好的非小细胞肺癌肿瘤标记物。癌胚抗原（ CEA）与腺癌之间有明显相关性。鳞状细胞癌抗原（SCC-Ag）和细胞角蛋白19片段（CYFRA21-1）与鳞癌之间有明显相关性。神经元特异性烯醇化酶（ NSE）与小细胞癌有明显相关性。对不宜手术的肺癌患者,四种肿瘤标记物对患者病理分型有较好的提示作用,并能对临床的针对性治疗提供一定的帮助。     

食管鳞状细胞癌同步放化疗预后影响因素分析

目的 评估食管癌患者同步放化疗预后的影响因素.方法 经病理确诊食管鳞状细胞癌80例,接受多西紫杉醇135～ 175 mg/m2第1天,顺铂40 mg/m2第2、3天化疗,同时给予60 Gy放疗,在治疗前及治疗4个周期后分别测定美国东部肿瘤协作组（ECOG,0～1）评分、肿瘤发生部位、肿瘤大小、TNM分期及CA199、SCC-Ag水平,并分析预后与CA199、SCC-Ag水平的关系.用Cox回归分析各项指标与总生存率的关系.结果 所有患者均完成4个周期同步放化疗,主要不良反应为粒细胞减少、脱发、恶心、呕吐、腹泻.其中严重不良反应为Ⅲ度粒细胞减少2例（2.5％）,所有不良反应经对症处理后均恢复正常.60岁以上患者5年中位生存期为50个月,而60岁以下为72.5个月（P=0.004）.临床分期cT1～2N1M0患者5年生存率为73.3％,cT3N1M0为69.4％,cT4N0M0为41.7％,cT4N1M0为0（P=0.024）;肿瘤在食管上胸段的患者5年生存率为42.9％,食管中胸段为70.0％,食管下胸段为60.9％（P=0.971）.ECOG分期为0期的患者5年生存率为100％,Ⅰ期患者为54.1％（P=0.044）;CA199≤37 kU/L的患者5年生存率为86.7％,明显高于＞37 kU/L（52.0％）（P=0.008）;SCC-Ag≤1.9 μg/L患者5年生存率为95.5％,＞1.9 μg/L的患者5年生存率为53.4％（P=0.012）.结论 患者年龄、TNM分期、ECOG评分、CA199和SCC-Ag均可作为同步放化疗后食管癌患者独立的预后指标.