肾盂尿路上皮癌患者尿 NMP22、TPS、CYFRA21-1、CA19-9的检测与评估

目的探讨尿液核基质蛋白22(nuclear matrix protein 22,NMP22)、组织多肽特异性抗原(tissue polypeptide-specific antigen,TPS)、CYFRA21-1、糖链蛋白19-9(carbohydrate antigen 19-9,CA19-9)对肾盂尿路上皮癌的诊断价值.方法回顾性分析山西省肿瘤医院2010年1月至2015年12月检测的至少两种上述尿液肿瘤标志物的患者资料,共218人次,包括肾盂尿路上皮癌63例(A 组)、膀胱尿路上皮癌46例(B 组)、非尿路上皮肿瘤的泌尿系其他疾病62例(C 组)、A组行根治术后2年未复发47例(D 组),另有健康志愿者20例(E 组).比较各组尿 NMP22、TPS、CYFRA21-1、CA19-9表达水平,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算 ROC 曲线下面积.结果 A 组 NMP22水平高于 B 组,差异有统计学意义(P ＝0．001). A 组与 B 组的 TPS、CYFRA21-1、CA19-9水平差异无统计学意义(P ＞0．05).A 组和 B 组的 TPS、NMP22、CYFRA21-1、CA19-9水平均高于 C 组、D 组、E 组,差异有统计学意义(P ＜0?05).C 组、D组及 E 组的 NMP22、TPS、CYFRA21-1、CA19-9水平差异无统计学意义(P ＞0．05). A 组中NMP22、TPS、CYFRA21-1、CA19-9水平在不同病理分级、临床分期、肿瘤大小、是否肾积水等的差异无统计学意义(P ＞0．05).A 组 NMP22、TPS、CYFRA21-1、CA19-9的诊断准确率高于尿脱落细胞学检查,差异有统计学意义(P ＜0．05).四种肿瘤标志物的 ROC 曲线下面积为0．7~0．9,诊断效能中等,最高者为 NMP22与 CYFRA21-1的组合,为0．884.结论尿液 NMP22、TPS、CYFRA21-1、CA19-9对肾盂尿路上皮癌的诊断有帮助,诊断效能中等,但它们对肾盂癌肿瘤分期和病理分级的预测、术后监测、预后判断等方面的作用有待进一步研究.

Evaluation of NMP22,TPS,CYFRA21-1 and CA19-9 in the urine of patients for the diagnosis of urothelial carcinoma of renal pelvis

Objective To study the diagonsis value of urinary tissue polypeptide-specific anti-gen (TPS),nuclear matrix protein 22 (NMP22 ),CYFRA21-1 and carbohydrate antigen 1 9-9 (CA1 9-9)in urothelial carcinoma of renal pelvis. Methods The study was a retrospective analysis with clinical data of cases of urothelial carcinoma of renal pelvis in Shanxi Provincial Tumor Hospital from 2010 January to 201 5 December,including 238 urine samples from 63 cases with urothelial car-cinoma of the renal pelvis (group A),46 cases with urothelial carcinoma of the urinary bladder (group B),62 cases with other urological diseases (group C),47 cases with no recurrence after radi-cal resection from the renal pelvis group for at least 2 years (group D),20 volunteers from our hos-pital (group E).Voided urine samples were collected before cystoscopies or surgeries.NMP22, TPS,CYFRA21-1,CA1 9-9 were measured by chemiluminescent immunoassays.We evaluated their concentration of urine and draw receiver operating characteristic cutoffs curves,and calulated the are-as under the ROC curves for further statistical analysis.Results The urine concentration of NMP22 in group A was higher than that in group B,the difference was statistically significant (P =0.001). There was no significant difference in the urine concentrations of TPS,CYFRA21-1 and CA1 9-9 between group A and group B (P >0.05).The urine concentrations of CA1 9-9,NMP22,CYFRA21-1 and TPS in group A were higher than that in group C, group D and group E,and the differences were statistically significant (P <0.05).The urine concentrations of NMP22,TPS, CYFRA21-1 and CA1 9-9 in group B were higher than those in group C,group D and group E,and there were significant differ-ences (P <0.05).There was no significant difference in the urine concentrations of NMP22,TPS,CYFRA21-1 and CA1 9-9 a-mong the group C,group D and group E (P >0.05).The urine concentrations of NMP22,TPS,CYFRA21-1,CA1 9-9 in the group A were not statistically significant (P >0.05)between group of different pathological grades,clinical stages,tumor size, and whether there was hydronephrosis or not.The diagnostic accuracy of NMP22,TPS,CYFRA21-1 and CA1 9-9 were higher than that of urine cytology in group A by paired sample McNemar tests,and the differences were statistically significant (P <0.05).The areas under the ROC curves of the four tumor markers were all in 0.7-0.9,and the diagnostic efficacies were moder-ate,with the highest one was the combination of NMP22 and CYFRA21-1,which was 0.884. Conclusions NMP22,TPS, CYFRA21-1,CA1 9-9 in urine have moderate diagnostic value for patients with urothelial carcinoma of the renal pelvis.Howev-er more study should be performed for their value for prediction of tumor stage,and pathological classification,and prognosis.