血清CEA、 CYFRA21-1和SCC对晚期非小细胞肺癌化疗效果的评估价值

目的 探讨血清癌胚抗原(carcinoembryonic antigen,CEA)、细胞角蛋白19片段(cytokeratin fragment 19,CYFRA21-1)和鳞状上皮细胞癌抗原(squamous cell cancinomaantigen,SCC)对晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)化疗效果的评估价值.方法 选取2010年1月至2016年12月我院收治的94例诊断明确的初治晚期(Ⅲb～Ⅳ期)NSCLC患者,并选择同期于我院进行体检的健康者83例为对照组,给予NSCLC组患者含铂类全身化疗2周期,分别检测NSCLC组患者化疗前后及健康对照组的血清CEA、CYFRA21-1和SCC浓度水平.根据影像学的实体瘤疗效评价标准(response evaluation criteria in solid tumors,RECIST)判定化疗疗效,分为完全缓解(complete remission,CR)、部分缓解(partial remission,PR)、稳定(stable disease,SD)和进展(progressive disease,PD).探讨化疗前后血清CEA、CYFRA21-1和SCC水平变化与晚期NSCLC化疗效果的关系.结果 NSCLC组患者血清CEA、CYFRA21-1和SCC水平明显高于健康对照组(P＜0.05).NSCLC组化疗前腺癌组患者血清CEA水平明显高于鳞癌组患者(P＜0.05),鳞癌组患者血清CYFRA21-1、SCC水平明显高于腺癌组患者(P＜0.05).NSCLC组94例患者全身化疗2周期后CR0例,PR 36例(鳞癌14例,腺癌22例),SD 32例(鳞癌14例,腺癌18例),PD 26例(鳞癌11例,腺癌15例).鳞癌组PR患者化疗后血清CYFRA21-1、SCC水平较化疗前明显下降(P＜0.05),SD患者化疗后血清CYFRA21-1、SCC水平较化疗前无明显变化(P＞0.05),PD患者化疗后血清CYFRA21-1、SCC水平较化疗前明显升高(P＜0.05);腺癌组PR患者化疗后血清CEA水平较化疗前明显下降(P＜0.05),SD患者化疗后血清CEA水平较化疗前无明显变化(P＞0.05),PD患者化疗后血清CEA水平较化疗前明显升高(P＜0.05).结论 血清肿瘤标志物CEA、CYFRA21-1及SCC可分别作为晚期肺腺癌和肺鳞癌的化疗疗效和进展评估的敏感指标.

Clinical Value of Serum CEA,CYFRA21-1 and SCC for Evaluation of Chemotherapy Efficacy in Patients with Advanced Non-small Cell Lung Cancer

Objective To investigate the clinical value of serum carcinoembryonic antigen (CEA),cytokeratin fragment 19 (CYFRA21-1) and squamous cell carcinoma antigen (SCC) for evaluation of chemotherapy efficacyin patients with advanced non-smallcelllung cancer (NSCLC).Methods A total of 94 patients with NSCLC who were diagnosed with advanced stages (stage m b-Ⅳ) from January 2010 to December 2016 were selected as case group and 83 healthy people were selected as the control group.Patients with NSCLC were treated with platinum-based systemic chemotherapy for 2 cycles.The levels of serum CEA,CYFRA21-1 and SCC were measured in the healthy control group and before and after chemotherapyfor the patients with NSCLC.The efficacy of chemotherapy was determined according to the response evaluation criteria in solid tumors (RECIST),and then divided into complete remission(CR),partial remission(PR),stabledisease (SD) and progressivedisease(PD).We investigated the relationship between serum CEA,CYFRA21-1 and SCC levels before and after chemotherapy and the efficacy of chemotherapy in advanced NSCLC.Results The levels of serum CEA,CYFRA21-1 and SCC in the patients with NSCLC were significantly higher than those in the healthy control group (P ＜ 0.05).The level of serum CEA in patients with adenocarcinoma was significantly higher than that in squamous cell carcinoma group (P ＜ 0.05),while the levels of serum CYFRA21-1 and SCC in the squamous cell carcinoma group were significantly higher than those in the adenocarcinoma group(P ＜ 0.05).There was 0 case of CR,36 cases of PR (14 cases of squamous cell carcinoma,22 cases of adenocarcinoma),32 cases of SD(14 cases of squamous cell carcinoma and 18 cases of adenocarcinoma) and 26 cases of PD (11 cases of squamous cell carcinoma and 15 cases of adenocarcinoma) among all the 94 patients with NSCLC after 2 cycles of systemic chemotherapy.In the squamous cell carcinoma group,the levels of serum CYFRA21-1 and SCC in PR patients were significantly lower than those of before chemotherapy (P ＜ 0.05).There was no significant change in the levels of serum CYFRA21-1 and SCC in SD patients(P ＞ 0.05).And the levels of CYFRA21-1 and SCC in PD patients were significantly higher than those of before chemotherapy (P ＜ 0.05).In the adenocarcinoma group,the level of serum CEA in PR patients was significantly lower than that of before chemotherapy (P ＜ 0.05).There was no significant change in serum CEA level in SD patients (P ＞ 0.05).The level of serum CEA in PD patients was significantly higher than that of before chemotherapy (P ＜ 0.05).Conclusion Serum markers CEA,CYFRA21-1 and SCC can be used as the sensitive indicatorsto evaluation the chemotherapy efficacyand the progression of advanced lung adenocarcinoma and lung squamous cell carcinomarespectively.