多种肿瘤标志物水平与与非小细胞肺癌靶向动脉灌注治疗效果及预后的相关性分析

目的探讨癌胚抗原(CEA),神经元特异性烯醇化酶(NSE),胃泌素释放肽前体(Pro-GRP),细胞角蛋白19片断(Cyfra)21-1,鳞状细胞癌抗原(SCC-Ag)检测水平与非小细胞肺癌(NSCLC)靶向动脉灌注治疗有效性及预后的相关性。方法回顾性分析110例接受靶向动脉灌注治疗的晚期NSCLC患者的临床资料,根据治疗效果将其分为有效组和无效组,对比2组治疗前后血清肿瘤标志物水平:CEA,NSE,Pro-GRP,Cyfra21-1,SCCAg,通过绘制受试者工作曲线(ROC),分析各血清肿瘤标志物与NSCLC靶向治疗效果一致性;随访1年,根据患者预后情况将其分为生存组和死亡组,对比2组治疗后血清肿瘤标志物水平,并对比2组可能影响预后死亡因素的差异,采用Logistic回归分析法明确相关危险因素。结果靶向动脉灌注治疗有效率50.91%,治疗后有效组血清CEA,NSE,Pro-GRP,Cyfra21-1,SCCAg水平均低于治疗前,且均低于无效组(P<0.05);治疗后无效组血清CEA,NSE,Pro-GRP,SCCAg水平与治疗前相比无明显变化(P>0.05),而血清Cyfra21-1水平较治疗前升高(P<0.05);CEA,NSE,Pro-GRP,Cyfra21-1,SCCAg对NSCLC靶向治疗疗效诊断最佳截断点分别为20.0μg/L、13.3μg/L、10.7 ng/L、3.1μg/L、1.2μg/L,AUC分别为0.470、0.513、0.702、0.710、0.683。随访1年生存率40.91%;死亡组血清CEA,NSE,Pro-GRP,Cyfra21-1,SCCAg水平均高于生存组(P<0.05);死亡组TNMⅣ期、CEA>5μg/L、NSE>16.3μg/L,Pro-GRP>40.0 ng/L,Cyfra21-1>3.3μg/L,SCCAg>1.4μg/L患者构成比均高于生存组(P<0.05),且经Logistic回归分析,上述指标均是导致预后死亡的危险因素(P<0.05)。结论血清CEA,NSE,Pro-GRP,Cyfra21-1,SCCAg检测与NSCLC靶向动脉灌注治疗有效性和预后密切相关,且Cyfra21-1对疗效有较高诊断效能。

Correlation of tumor markers level with effectiveness and prognosis of non-small cell lung cancer received targeted arterial infusion therapy

Objective To investigate the correlation of carcinoembryonic antigen(CEA),neuron specific enolase(NSE),gastrin releasing peptide precursor(Pro-GRP),cytokeratin 19 fragment(Cyfra)21-1,and squamous cell carcinoma antigen(SCC-Ag)with effectiveness and prognosis of non-small cell lung cancer(NSCLC)received targeted arterial infusion therapy.Methods The clinical data of 110 patients with advanced NSCLC treated by targeted arterial infusion therapy were retrospectively analyzed.According to the therapeutic effect,they were divided into the effective group and the ineffective group.The serum tumor markers level before and after treatment was compared between the two groups:CEA,NSE,Pro-GRP,Cyfra21-1,SCCAg.The consistency between serum tumor markers and NSCLC targeting therapy was analyzed by plotting the receiver working curve(ROC).After 1-year follow-up,the patients were divided into the survival group and the death group according to their prognosis.The serum tumor markers were compared between the two groups,and the differences between the two groups were compared.Logistic regression analysis was used to identify the relevant risk factors.Results The effective rate of targeted arterial infusion therapy was 50.91%.The levels of serum CEA,NSE,Pro-GRP,Cyfra21-1 and SCCAg in the effective group after treatment were lower than those before treatment,and they were lower than those in the ineffective group(P<0.05).The levels of serum CEA,NSE,Pro-GRP and SCCAg in the ineffective group after treatment were not significantly different from those before treatment(P>0.05),while the serum Cyfra21-1 level was higher than before treatment(P<0.05).The best cut-off points of CEA,NSE,Pro-GRP,Cyfra21-1 and SCCAg for the diagnosis of therapeutic efficacy of targeted NSCLC were 20.0μg/L,13.3μg/L,10.7 ng/L,3.1μg/L and 1.2μg/L,and AUC were 0.470,0.513,0.702,0.710 and 0.683,respectively.The 1-year survival rate was 40.91%.The serum CEA,NSE,Pro-GRP,Cyfra21-1 and SCCAg levels in the death group were higher than those in the survival group(P<0.05).The composition ratio of patients with TNM stageⅣ,CEA greater than 5μg/L,NSE greater than 16.3μg/L,Pro-GRP greater than 40.0 ng/L,Cyfra21-1 greater than 3.3μg/L and SCCAg greater than 1.4μg/L in the death group were higher than those in the survival group(P<0.05),and Logistic regression analysis showed that the above indexes were risk factors for prognosis and death(P<0.05).Conclusion The detection of serum CEA,NSE,Pro-GRP,Cyfra21-1 and SCCAg are closely related to the effectiveness and prognosis of NSCLC patietns received targeted arterial infusion therapy,and Cyfra21-1 has a higher diagnostic efficacy.