宫颈癌患者治疗前联合检测血清CYFRA21-1和SCCAg的临床意义

背景与目的：细胞角蛋白19片段抗原21—1（cytokeratin 19 fragment antigen21．1，CYFRA21-1）可用于细胞角蛋白19片段的定量检测，可作为多种恶性肿瘤的标记物。本研究旨在探讨宫颈癌患者治疗前血清CYFRA21—1和鳞状细胞癌抗原（squamous cell carcinoma antigen，SCCAg）联合检测对宫颈癌诊断的意义及其与临床病理特征的相关性。方法：对100例宫颈癌患者行治疗前血清CYFRA21．1及SCCAg检测，以20例健康妇女为对照，分析其作为诊断参考的特异性和敏感性，并对两者与宫颈癌临床病理特征的相关性进行单因素和多因素分析。结果：CYFRA21-1、SCCAg用于宫颈癌诊断的特异性均为100％。CYFRA21-1、SCCAg升高用于治疗前诊断的敏感性分别为36．0％和47．0％．两者差异无统计学意义（P〈0．05）。两者联合检测的敏感性达到60．0％，与CYFRA21-1单一指标相比，其差异有统计学意义（P〈0．05）。单因素分析示CYFRA21-1升高与FIGO分期、肿瘤大小相关：SCCAg升高与病理类型、肿瘤大小、宫颈深肌层浸润及盆腔淋巴结转移相关。多因素分析未发现与CYFRA21-1升高显著相关的临床病理因素：与SCCAg升高显著相关的因素为宫颈深肌层浸润和盆腔淋巴结转移。SCCAg升高用于预测盆腔淋巴结转移和宫颈深肌层浸润的敏感性均显著高于CYFRA21—1（75．0％眦29．2％，P=0．001：55．8％US．26．9％，P=0．024）。联合检测CYFRA21—1对提高SCCAg预测盆腔淋巴结转移和宫颈深肌层浸润的敏感度其差异无统计学意义（79．2％US．75．0％，P〉0．05；63．5％vs．55．8％，P〉0．05）。结论：CYFRA21-1对预测盆腔淋巴结转移、宫颈深肌层浸润的价值不及SCCAg。对于宫颈鳞癌患者，SCCAg是首选的肿瘤标志物。

Clinical significance of combined examination of pretreatment serum CYFRA21-1 and SCCAg in cervical cancer patients

Background and Objective： Cytokeratin 19 fragment antigen 21-1 （CYFRA21-1） can be used for the quantitative examination of fragment of cytokeratin 19, and is a valuable tumor marker in various malignancies. This study was to investigate the significance of pretreatment serum CYFRA21-1 and squamous cell carcinoma antigen （SCCAg） in diagnosis and their correlations to the clinicopathologic features of cervical carcinoma. Methods. One hundred cervical carcinoma patients underwent pretreatment serum CYFRA21-1 and SCCAg evaluation~ 20 healthy women were subjected as control. The specificity and sensitivity of CYFRA21-1 and SCCAg as diagnostic indexes were analyzed. their correlations to clinicopathologic features were investigated through univariate and multivariate analyses. Results： The specificity of CYFRA21-1 and SCCAg in diagnosing cervical cancer were both 100%. The sensitivity of CYFRA21-1 and SCCAg in diagnosing cervical cancer were 36.0% and 47.0% respectively, without significant difference. The combined examination of CYFRA21-1 and SCCAg elevated the sensitivity to 60.0% , which was significantly higher than that of examining CYFRA21-1 alone. Univariate analysis showed elevation of CYFRA21-1 was related with FIGO stage and tumor size~ elevation of SCCAg was related with pathologic type, tumor size, deep stromal invasion and pelvic node metastasis. Multivariate analysis showed that elevation of CYFRA21-1 had no relationship with any factors, while elevation of SCCAg was related with deep stromal invasion and pelvic node metastasis. The sensitivity of SCCAg in predicting pelvic node metastasis and deep stromal invasion were significantly higher than those of CYFRA21-1 （75.0% vs. 29.2%, P=0.001; 55.8% vs. 26.9%, P=0.024）, and the addition of CYFRA21-1 to SCCAg could not significantly improve the sensitivity compared with SCCAg alone （79.2% vs. 75.0%, P〉0.05~ 63.5% vs. 55.8%, P〉0.05）. Conclusion. The value of pretreatment serum CYFRA21-1 as predictor of pelvic node metastasis and deep st