Diagnostic value of CEA, CA 15-3, CA 19-9, CYFRA 21-1, NSE and TSA assay in pleural effusions

The aim of this study was to evaluate the individual and combined diagnostic utility of six tumor markers in patients with pleural effusion. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3), carbohydrate antigen 19-9 (CA 19-9), cytokeratin fragment 19 (CYFRA 21-1), neuron-specific enolase (NSE) and total sialic acid (TSA) were assayed in 74 patients with pleural effusions (44 malignant and 30 benign). All tumor markers except TSA and NSE were increased in both serum and pleural fluid of patients with malignant diseases. Using the cut-off values 3 ng/ml, 14 U/ml, 5 U/ml, 8 ng/ml and 70 mg/dl for pleural fluid CEA, CA 15-3, CA 19-9, CYFRA 21-1 and TSA, respectively, the sensitivity (%) and specificity (%) of these tumor markers were as follows: CEA; 52/77, CA 15-3; 80/93, CA 19-9; 36/83, CYFRA 21-1; 91/90, TSA; 80/67, for differentiating malignant effusions from benign. When CA 15-3 and CYFRA 21-1 combined, the sensitivity and specificity were increased (100 and 83%, respectively). Classifying the malignant effusions as bronchial carcinoma and malignant pleural mesothelioma, CEA was shown to have the highest sensitivity and specificity (88 and 90%, respectively) while the combination of CEA with other tumor markers increased sensitivity but decreased specificity. According to our results, tumor markers are not suitable for the differential diagnosis of malignancy.     

肿瘤标志物联合检测在良恶性胸腔积液鉴别诊断中的价值

 目的　探讨胸腔积液4种肿瘤标志物联合检测在良恶性胸腔积液鉴别诊断中的价值。方法　采用电化学发光免疫法检测126例胸腔积液患者（其中恶性组52例,良性组74例）癌胚抗原（CEA）、糖类抗原125（CA125）、糖类抗原15-3（CA15-3）和细胞角蛋白片段19（CYFRA21-1）水平, 并计算上述指标单独和与CEA联合检测在诊断中的敏感度、特异度、准确度和约登指数（YI）。结果　恶性组4种肿瘤标志物水平均明显高于良性组（P＜0.01）。单项检测各种肿瘤标志物的敏感度以CA125最高（90.4 %）,特异度以CYFRA21-1最高（79.7 %）,诊断准确度以CEA和CYFRA21-1最高（71.4 %）,YI以CEA最高（0.41）。联合检测较单项检测敏感度、准确度和YI明显提高,其中CEA、CYFRA21-1和CA15-3三项联合效果最好,敏感度为92.3 %,特异度为78.4 %,准确度为84.1 %,YI值最高为0.71。四项联合敏感度为94.2 %,特异度为75.7 %,准确度为83.3 %,YI值为0.70,与三项联合结果相比差异无统计学意义（P＞0.05）。结论　单项检测的诊断价值有限,CEA、CYFRA21-1和CA15-3三项联合效果最好、最经济,可指导患者恰当选择进一步的侵入性检查手段。     

Diagnostic value of CYFRA 21-1, CEA, CA 19-9, CA 15-3, and CA 125 assays in pleural effusions: analysis of 116 cases and review of the literature

Levels of tumor markers in pleural effusions may help to establish the diagnosis of pleural malignancy, but the precise diagnostic value of each marker remains unclear. The aim of this study was to assess the diagnostic value of five common pleural fluid tumor markers, carcinoembryonic antigen (CEA), cytokeratin fragment (CYFRA) 21-1, cancer antigen (CA) 15-3, CA 19-9, and CA 125, and to review the literature from the past 15 years. Pleural fluid samples were collected prospectively from 116 patients and assayed for CEA, CYFRA 21-1, CA 15-3, CA 19-9, and CA 125 levels. A MEDLINE search of the English-language literature from the past 15 years was also done. Effusions were classified as benign or malignant on the basis of their definitive pathologic or cytologic diagnoses. The levels of all pleural tumor markers were statistically significantly higher in the malignant group than in the benign group. The marker with the highest accuracy was CEA (85.3%); CA 15-3, CYFRA 21-1, and CA 19-9 had similar accuracies (75.2%, 72.4%, and 71.5%, respectively), and CA 125 had the lowest accuracy (40.5%). On univariate analysis, tumor-marker combinations did not result in a greater accuracy than that of CEA alone. On multivariate logistic regression, CA 15-3 and CYFRA 21-1 were significant predictors of malignancy. Among the nine reports in the literature comparing 11 different tumor markers, CEA, CA 15-3, and CYFRA 21-1 yielded the best results. We conclude that pleural fluid analysis should include CEA for the diagnosis of malignancy. CA 15-3 and CYFRA 21-1 may serve as alternative options.     

Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions

Carcinoembryonic antigen (CEA), carbohydrate antigens 15-3, 19-9 and 72-4 (CA 15-3, CA 19-9 and CA 72-4), cytokeratin 19 fragments (CYFRA 21-1), neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC) were evaluated in pleural fluid for the diagnosis of malignant effusions. With a specificity of 99%, determined in a series of 121 benign effusions, the best individual diagnostic sensitivities in the whole series of 215 malignant effusions or in the subgroup of adenocarcinomas were observed with CEA, CA 15-3 and CA 72-4. As expected, a high sensitivity was obtained with SCC in squamous cell carcinomas and with NSE in small-cell lung carcinomas. CYFRA and/or CA 15-3 were frequently increased in mesotheliomas. Discriminant analysis showed that the optimal combination for diagnosis of non-lymphomatous malignant effusions was CEA + CA 15-3 + CYFRA + NSE: sensitivity of 94.4% with an overall specificity of 95%. In malignant effusions with a negative cytology, 83.9% were diagnosed using this association. The association CYFRA + NSE + SCC was able to discriminate adenocarcinomas from small-cell lung cancers. Regarding their sensitivity and their complementarity, CEA, CA 15-3, CYFRA 21-1, NSE and SCC appear to be very useful to improve the diagnosis of malignant pleural effusions.     

Diagnostic utility of CYFRA 21-1, carcinoembryonic antigen, CA 125, neuron specific enolase, and squamous cell antigen level determinations in the serum and pleural fluid of patients with pleural effusions.

BACKGROUND: To the authors' knowledge the role of tumor marker determination in the differential diagnosis of pleural effusions has not been established definitively. The current article reports the results of a study of CYFRA 21-1, carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), squamous cell antigen (SCC), and neuron specific enolase (NSE) in the serum and pleural fluid of patients with pleural effusions of diverse etiologies. METHODS: One hundred forty-six patients with pleural effusions (43 malignant, 47 tuberculous, 32 miscellaneous benign, and 24 paramalignant) were studied prospectively. Levels of CYFRA 21-1, CA 125, CEA, NSE, and SCC were measured by radioimmunoassay in the pleural fluid in all patients and in the serum in 118 patients. RESULTS: There were no significant differences between the serum and pleural fluid levels of tumor markers with the exception of CA 125, which was higher in the pleural fluid. With maximum specificity, the highest sensitivity in the diagnosis of pleural malignancy was obtained with a combination of CYFRA 21-1 (with a cutoff value of 150 U/L), CEA (with a cutoff value of 40 ng/mL), and CA 125 (with a cutoff value of 1000 ng/mL) in pleural fluid. NSE and SCC added no diagnostic value. The simultaneous use of tumor markers and cytology in pleural fluid increased the sensitivity from 55.8% to 81%. CONCLUSIONS: These findings suggest that a combination of CYFRA 21-1, CEA, and CA 125 in the pleural fluid can be a useful addition to pleural cytology in the diagnosis of malignant pleural effusion.     

CA 72-4 radioimmunoassay in the diagnosis of malignant effusions. Comparison of various tumor markers

We evaluated the utility of the CA 72-4, CEA, CA 125, CA 19-9 and CA 15-3 radioimmunoassays for the detection of tumor-associated antigens (TAAs) in effusions of malignant vs. benign origin. Fluids were obtained from 51 patients with adenocarcinomas, 27 with non-epithelial malignancies, and 68 with benign disorders. The CA 72-4 radioimmunoassay (cut-off value 8.5 U/ml) detected the TAG-72 antigen in 51% of adenocarcinoma patients' effusions, while only 1 of 68 benign specimens had an elevated TAG-72 level. Similarly, CEA levels above 5 ng/ml were found in 55% of the fluids from patients with adenocarcinoma and 3.2% of effusions from patients with benign disease. CA 19-9 (cut-off value 37 U/ml) exhibited a lower degree of sensitivity, with positive values in 23.5% of the effusions due to adenocarcinomas and in 4.5% of the effusions due to benign disease. At a cut-off value of 29 U/ml, CA 15-3 was positive in 49% of fluids from patients with adenocarcinoma and in 3.0% of the benign fluids. The CA 125 RIA failed to show any specificity using the established cut-off value of 35 U/ml, with approximately 80% of all the effusions giving positive results. The specificity of the assay was increased by using a cut-off value of 3000 U/ml, but with a substantial loss in sensitivity (23.5%). Using a combination of the CA 72-4 and CEA RIAs the sensitivity for malignant effusions was increased to 73.5%. No additional improvement in the overall sensitivity was observed when using the CA 72-4 assay in combination with assays for the other markers, except in the case of 1 effusion. We conclude that the CA 72-4 RIA, possibly in combination with other assays such as CEA, may be useful in distinguishing between adenocarcinomatous and benign effusions.     

Diagnostic significance of the tumour markers CEA, CA 15-3 and CA 125 in malignant effusions in breast cancer

Concentrations of the tumour-associated antigens CEA, CA 15-3 and CA 125 were determined in serous effusions (EF) from patients (pts) with breast cancer. As controls, serous effusions from patients with benign and other malignant diseases were used. The EF levels were also compared with those of serum. CA 15-3 was elevated (greater than 35 U/ml) in 65.7% of breast cancer EF, in 39.3% of EF in various other malignant diseases and in 0% of benign EF. CEA was elevated (greater than 9 ng/ml) in 37.5% of breast cancer EF, in 17.9% of EF of various other malignant diseases and in 27% of benign EF. CA 125 was elevated (greater than 35 U/ml) in 93.8% of breast cancer EF, in 78.6% of EF of various other malignant diseases and in 58.8% of benign EF. There was a statistically significant correlation between EF and serum values for the markers studied. Sensitivity and specificity for CA 15-3 were 65.7% and 76.6%, for CEA 37.5% and 77.7% and for CA 125 93.8% and 28.7%, respectively. CA 15-3 is a marker with definite diagnostic accuracy compared to CEA and CA 125 in breast cancer EF. CA 125 appears to derive from proliferating mesothelia rather than cancer cells alone and occurs in a broad spectrum of malignant as well as benign EF. The above markers should not be used alone for diagnosis of breast cancer in patients with serous effusions.     

Evaluation of pleural CYFRA 21-1 and carcinoembryonic antigen in the diagnosis of malignant pleural effusions.

CYFRA 21-1 assay, measuring cytokeratin 19 fragments, was compared with carcinoembryonic antigen (CEA) assay, as an addition to cytological analysis for the diagnosis of malignant effusions. Both markers were determined with commercial enzyme immunoassays in pleural fluid from 196 patients. Cytological analysis and/or pleural biopsy confirmed the malignant origin of the effusion in 99 patients (76 carcinomas, nine pleural mesotheliomas and 14 non-epithelial malignancies). Effusions were confirmed as benign in 97 patients (33 cardiac failures, 39 infectious diseases--including 12 tuberculosis-- and 25 miscellaneous effusions). Both markers were significantly higher in malignant than in benign effusions. All the patients with non-epithelial malignancies presented CYFRA and CEA values lower than the 95% diagnostic specificity thresholds (100 and 6 ng ml(-1) respectively). The diagnostic sensitivity in the group of carcinomas and mesotheliomas was similar for CYFRA (58.8%) and CEA (64.7%). However, CEA had a significantly higher sensitivity in carcinomas (72.4% vs 55.3%), while CYFRA had a clearly higher sensitivity in mesotheliomas (89.9% vs 0%). Interestingly, 12 out of the 16 malignant effusions with a negative cytology were CEA and/or CYFRA positive. Regarding their high diagnostic sensitivity and their complementarity, CEA and CYFRA appear to be very useful for the diagnosis of malignant pleural effusions when cytology is negative.     

Diagnostic value of tumor markers for differentiating malignant and benign pleural effusions of Iranian patients

In order to evaluate the diagnostic yield of tumor markers in differentiating malignant and benign pleural effusions, we carried out a prospective study in a group of Iranian people. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA15-3), neuron-specific enolase (NSE) and cancer antigen 125 (CA 125) were assayed prospectively in patients with pleural effusion (40 malignant and 37 benign). The highest sensitivity was obtained with a combination of CA 15-3 in serum, and CA 15-3 and CEA in pleural fluid (80%), also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid (80%). The highest specificity was obtained with combination of CA 15-3 in serum, and CA 15-3 and NSE in pleural fluid (100%), and also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid (100%).     

Clinical Evaluation of Tumor Markers for Diagnosis in Patients with Non-small Cell Lung Cancer in China

Background: To evaluate the value of combined detection of serum carcinoembryonic antigen (CEA),cytokeratin 19 fragment (CYFRA21-1), and carbohydrateantigen 125 (CA125) for the clinical diagnosis of nonsmallcell lung cancer (NSCLC). Materials and Methods: Serum CEA, CYFRA21-1 and CA125 were assessed in140 patients with NSCLC, 90 patients with benign lung disease and 90 normal control subjects, and differencesof expression were compared in each group, and joint effects of these tumor markers in the diagnosis of NSCLCwere analyzed. Results: Serum CEA, CYFRA21-1 and CA125 in patients with NSCLC were significantly higherthan those with benign lung disease and normal controls (P<0.05). The sensitivity of CEA, CYFRA21-1 andCA125 were 49.45%, 59.67%, and 44.87% respectively. As expected, combinations of these tumor markersimproved their sensitivity for NSCLC. The combined detection of CEA + CYFRA21-1 was the most cost-effectivecombination which had higher sensitivity and specificity in NSCLC. Elevation of serum CEA and CYFRA21-1was significantly associated with pathological types (P<0.05) and elevation of serum CEA, CYFRA21-1 andCA125 was significantly associated with TNM staging (P<0.05). Conclusions: Single measurement of CEA,CYFRA21-1 and CA125 is of diagnostic value in the diagnosis of lung cancer, and a joint detection of these threetumor markers, could greatly improve the sensitivity of diagnosis on NSCLC. Combined detection of CEA +CYFRA21-1 proved to be the most economic and practical strategy in diagnosis of NSCLC, which can be usedto screen the high-risk group.     

六种肿瘤标志物在肺癌胸腔积液中的诊断价值

目的通过对胸腔积液和血清中6种肿瘤标志物的检测及胸腔积液脱落细胞学检查,探讨各指标在肺癌胸腔积液中的诊断价值。方法应用化学发光法和酶联免疫分析法测定50例肺癌和30例肺良性疾病患者的胸腔积液和血清中的癌胚抗原（CEA）、糖类抗原19—9（CA19—9）、鳞状细胞癌抗原（SCC）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（CYFRA21—1）、胃泌素前体释放肽（ProGRP）水平,同时对胸腔积液标本进行脱落细胞学检查,并根据受试者工作特性曲线（ROC）建立合理的临床判断临界值。结果肺癌患者胸腔积液中6种肿瘤标志物水平均高于肺良性疾病者,其中CEA、CA19-9、CYFRA21—1、ProGRP水平显著高于肺良性疾病组（P〈0．05）。胸腔积液CEA、血清CYFRA21—1及CEA含量在胸腔积液与血清中的比值（P／S）在各组中的ROC曲线下面积最大。结论胸腔积液CEA、血清CYFRA21—1及CEA的P／S值在鉴别良、恶性胸腔积液中有一定的辅助诊断价值,胸腔积液CEA的诊断价值最大。     

血清肿瘤标志物单项及联合检测在肺癌诊断中的临床价值

目的探讨血清癌胚抗原(Carcinoembryonic antigen,CEA)、糖类抗原19-9(CA19-9)、糖类抗原125(CA125)、细胞角蛋白19片断(Cytokeratinfragment 19,CYFRA21-1)、神经特异性烯醇化酶(Neuron-specific enolase,NSE)、鳞状细胞抗原(SCC-Ag)6种肿瘤标志物单项及联合检测在肺癌诊断中的临床价值。方法采用化学发光免疫法检测92例肺癌患者、92例肺良性疾病患者、92例健康体检者的血清CEA、CA19-9、CA125、CYFRA21-1、NSE、SCC-Ag表达水平。结果肺癌患者的血清肿瘤标志物CEA、CA19-9、CA125、CYFRA21-1、NSE、SCC-Ag的表达均明显高于肺良性疾病患者和健康体检者(P均<0.05);6种肿瘤标志物对肺癌诊断的灵敏性和准确度分别为:CEA(51.1%、73.3%)、CY-FRA21-1(58.7%、73.9%)、CA125(38.0%、71.4%))、CA19-9(27.2%、70.3%)、NSE(26.1%、65.9%)、SCC-Ag(35.9%、71.0%),而六者联合检测的灵敏性和准确度分别为92.4%和83.7%,明显高于各单项检测(P<0.05)。结论血清肿瘤标志物CEA、CA19-9、CA125、CYFRA21-1、NSE、SCC-Ag是诊断肺癌较好的标志物,六者联合检测可明显提高肺癌诊断的灵敏性和准确度。     

DNA倍体联合肿瘤标志物检测在胸腔积液诊断中的应用

目的探讨DNA倍体分析联合肿瘤标志物在良、恶性胸腔积液诊断中的价值。方法将108例胸腔积液分为恶性组（68例）和良性组（40例）。除常规细胞学检查外,以流式细胞术（flowcytometry,FCM）检测患者胸腔积液中的DNA倍体,采用化学发光法测定胸腔积液中CEA、CA199、NSE、CYFRA211、SCC、CA125等肿瘤标志物含量。比较DNA倍体联合肿瘤标志物诊断与细胞学诊断的优劣。结果DNA倍体诊断恶性胸腔积液的敏感性、特异性分别为70．6％、95．0％,Youden’s指数为0．656,敏感度稍高于细胞学诊断的65．1％,差异无统计学意义（P〉0．05）。除NSE外,其他5种肿瘤标志物在恶性胸腔积液中浓度均高于良性,差异有统计学意义（P〈0．05）。CYFRA211、CEA、CAl99、CAl25、SCC、NSE的AUC分别为：0．893,0．828,0．759,0．691,0．524及0．490;COV分别为：149．2ng／mL,53．6ng／mL,78．2IU／mL,1559．0IU／mL,48．72ng／mL及78．3ng／mL;敏感性分别为：44．1％,44．1％,35．3％,29．4％,13．2％,5．9％,特异性均为100％。4种肿瘤标志物联合检测＋DNA倍体检测的敏感性为88．2％（60／68）,特异性95％,显著高于细胞学诊断。结论DNA倍体联合CEA、CA199、CYFRA211和CA125检测诊断恶性胸腔积液有较高敏感性,具有定量、快速、价廉、易标准化的特点,且操作简单。     

Clinical Observations on the Association Between Diagnosis of Lung Cancer and Serum Tumor Markers in Combination

Objective: To evaluate the association of a diagnosis of lung cancer and combined detection of serumcarcinoembryonic antigen (CEA), carbohydrateantigen 19-9 (CA19-9), neuron specific enolase (NSE) as well asthe cytokeratin 19 fragment (CYFRA21-1). Methods: Serum CEA, CA19-9, NSE and CYFRA21-1 were assessedin 150 patients with lung cancer, 100 patients with benign lung disease and 100 normal control subjects, anddifferences of expression were compared in each group, and joint effects of these tumor markers in the diagnosisof lung cancer were analyzed. Results: Serum CEA, CA19-9, NSE and CYFRA21-1 in patients with lung cancerwere significantly higher than those with benign lung disease and normal controls (p<0.01). It is suggested thatthese four tumor markers combined together could produce a positive detection rate of 90.2%, significantlyhigher than that of any single test. Conclusion: Combination detection of CEA, CA19-9, NSE and CYFRA21-1could significantly improve the sensitivity and specificity in diagnosis of lung cancer, and could be important inearly detection.     

血清和腹水肿瘤标志物对良、恶性腹水的鉴别诊断价值

目的 探讨血清和腹水AFP、CEA、CA125、CA19-9对良、恶性腹水鉴别诊断的价值.方法 70例腹水患者根据病因分为良性组和恶性组,比较2组患者血清和腹水肿瘤标志物的水平.结果 恶性组血清和腹水中AFP、CEA、CA19-9水平均高于良性组(P均＜0.05).血清AFP、CEA、CA19-9联合检测的敏感性、特异性和准确性分别为61.90％、82.14％和70.00％,腹水AFP、CEA、CA19-9联合检测的敏感性、特异性和准确性分别为57.14％、88.46％和67.14％.结论 血清和腹水AFP、CEA、CA19-9的检测有助于良、恶性腹水的鉴别,血清或腹水AFP、CEA、CA19-9联合检测可提高恶性腹水诊断的敏感性和准确性.     

Tumor markers in dialysis-dependent renal failure. A comparison of the mucin-like carcinoma antigen, CA 15-3, CA 125, CA 19-9 and CEA antigens

The concentration of tumor markers in human sera is affected not only by malignant, but also by many benign diseases. In this regard, only few reports exist about renal insufficiency, whereas influences of different liver diseases have frequently been described. We determined the serum levels of the antigens MCA, CA 15-3, CA 125, CA 19-9, and CEA in 50 patients suffering from renal insufficiency in chronic hemodialysis, but without indication of malignant diseases. We found no difference between the serum concentrations of MCA and CA 125 as compared to the healthy control group, whereas the other antigens were more often elevated in the group of patients (CEA, 24% of patients greater than 5 ng/ml; CA 15-3, 20% of patients greater than 30 U/ml; CA 19-9, 14% of patients greater than 40 U/ml). We did not find any correlation between pathological values of markers and diseases leading to renal failure. As the increase of tumor markers could not be explained by concomitant diseases, it seems likely that the terminal renal insufficiency plays a causal role.     

Tumor Markers in Serum and Ascites in the Diagnosis of Benign and Malignant Ascites

Objective: To evaluate the values of 4 tumor markers in serum and ascites and their ascites/serum ratios inthe identification and diagnosis of benign and malignant ascites. Materials and Methods: A total of 76 patientswere selected as subjects and divided into malignant ascites group (45 cases) and benign ascites group (31cases). Samples of ascites and serum of all hospitalized patients were collected before treatment. The levels ofcarcinoembryonic antigen (CEA), alpha fetoprotein (AFP), cancer antigen 125 (CA125) and carbohydrate antigen19-9 (CA19-9) were detected by chemiluminescence (CLIA) . Results: CEA, AFP and CA19-9 in both serumand ascites as well as CA125 in ascites were evidently higher in the malignant ascites group than in the benignascites group (P<0.01). Malignant ascites was associated with elevated ascites/serum ratios for AFP and CA125(P<0.01). The areas under receiver operating characteristic (AUROCs) of CEA and CA125 in ascites and theratios of ascites/serum of AFP, CEA, CA125 and CA19-9 were all >0.7, suggesting certain values, while those ofascites CA19-9 and serum CEA were 0.697 and 0.629 respectively, indicating low accuracy in the identificationand diagnosis of benign and malignant ascites. However, the AUROCs of the remaining indexes were <0.5, with novalue for identification and diagnosis. Compared with single index, the sensitivity of combined detection increasedsignificantly (P<0.05), in which the combined detection of CEA, CA19-9 and CA125 in ascites as well as the ratioof ascites/serum of CEA, CA19-9, CA125 and AFP had the highest sensitivity (98.4%) but with relevantly lowspecificity. Both sensitivity and specificity of combined detection should be comprehensively considered so asto choose the most appropriate index. Conclusions: Compared with single index, combined detection of tumormarkers in serum and ascites can significantly improve the diagnostic sensitivity and specificity.     

血清及胸腔积液中四种肿瘤标志物联合应用对良恶性肿瘤鉴别诊断价值的评估

目的探讨肿瘤标志物CEA、CA125、CA15-3及CA19-9联合应用对鉴别良性胸腔积液(BPE)和恶性胸腔积液(MPE)的价值。方法收集327例2013-01-01-2015-06-30在首都医科大学附属北京朝阳医院(174例)和华中科技大学同济医学院附属协和医院呼吸与危重症医学科(153例)住院的胸腔积液(PE)患者,其中MPE患者119例,BPE患者208例。取PE标本及配对血清标本,应用化学发光法检测CEA、CA125、CA15-3及CA19-9在血清及PE中的浓度,应用二元Logistic回归模型和L1正则化(LASSO)方法将患者基本信息与PE、血清中4种肿瘤标志物CEA、CA125、CA15-3及CA19-9进行不同方式的联合,通过受试者工作特征(ROC)曲线分析和比较不同联合诊断模型的诊断价值。结果PE中CEA+CA15-3+CA19-9的联合模型对应ROC曲线下面积(AUC)值最大(0.90),血清中此联合模型对应的AUC值也是最佳(0.863),PE中的联合模型优于血清中的联合诊断模型,P=0.0125,综合预测能力最强。PE与血清肿瘤标志物浓度差值中CEA+CA15-3+CA19-9的联合模型对应的灵敏度最佳(80.2%),特异度为79.1%。基于LASSO变量选择方法的联合模型在PE中的特异度最佳(96%),此时灵敏度为73%,阳性似然比22。以上结果均P<0.001。PE中CEA+CA15-3+CA19-9的联合模型对应的AUC值(0.90)优于PE中CEA对应的AUC值(0.824),P<0.001。结论联合应用CEA、CA15-3及CA19-9在诊断效能、灵敏度、特异度、阳性似然比等方面优于其他组合,且优于PE中的CEA对BPE/MPE的鉴别诊断价值。     

血清肿瘤标记物测定在卵巢成熟畸胎瘤及其恶变者的临床应用

背景与目的：测定卵巢成熟畸胎瘤以及恶变患者的肿瘤标记物CA125、CA19—9、SCC、CEA及AFP的水平，同时探讨它们与患者临床资料结合在卵巢成熟畸胎瘤恶变诊断方面的价值。方法：分析1997-2004年12月在我院妇产科手术，病理证实为卵巢成熟畸胎瘤的176例患者的临床病理资料，同时测定多种血清肿瘤标记物。结果：170例卵巢成熟畸胎瘤患者，平均年龄35．8岁，肿瘤平均大小为8．8cm，CA125测定153例，平均值33u／ml，其中37例〉35u／ml，CA19—9测定140例，平均值217u／ml，其中77例〉37u／ml，SCC测定112例，平均值1．82ng／ml，其中29例〉1．5ng／ml；CEA测定115例，平均值1．42ng／ml，其中8例〉5ng／ml；恶性变6例，平均年龄47岁，肿瘤平均大小17．6cm，CA125平均值500u／ml，其中5例〉35u／ml，CA19-9平均值609．8u／ml，其中5例〉37u／ml．SCC平均值23．4ng/ml，其中5例〉1．5ng／ml，CEA平均值22．8ng／ml，其巾4例〉5ng/ml。成熟畸胎瘤恶变的发病年龄以及肿瘤直径明显大于卵巢成熟囊性畸胎瘤的平均发病年龄和肿瘤直径（P〈0．05）；成熟畸胎瘤恶变的肿瘤标记SCC、CA125、CA19-9、CEA平均值明显高于卵巢成熟囊性畸胎瘤的平均值（P〈0．05）。结论：对于40岁以上，肿瘤直径超过10cm以上者，术前应注意肿瘤标记联合测定的结果，以鉴定肿瘤有无恶变。