血清胃泌素释放肽前体检测对小细胞肺癌诊断及预后的临床价值

目的探讨血清胃泌素释放肽前体(pro-GRP)对小细胞肺癌(SCLC)的诊断及预后价值。方法选取2018年1月至2021年1月吉林大学第一医院经病理组织学确诊为肺癌的2 584例患者,其中SCLC 132例,非小细胞肺癌(NSCLC)2 452例。采用电化学发光免疫分析法(Roche Cobas e601)检测各组血清pro-GRP、神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、细胞角蛋白片段19(CYFAR21-1)、鳞状细胞癌抗原(SCC)等肿瘤标志物的表达水平,采用ROC曲线评估各肿瘤标志物单项及联合检测诊断肺癌的临床效能;连续监测132例SCLC患者血清pro-GRP和NSE水平的变化,分析血清pro-GRP和NSE水平与患者预后的符合度。结果 SCLC组pro-GRP水平显著高于其他各亚组(P0.05)。pro-GRP诊断肺癌的ROC曲线下面积(AUC~(ROC))、敏感性、特异性分别为0.976、76.6%、99.7%,5项标志物联合检测诊断肺癌的敏感性、特异性、阳性预测值、阴性预测值及总有效率均高于单项检测(P均0.05)。对于化疗有效的患者,第2个周期后血清pro-GRP水平显著低于基线水平(P0.001)。对于耐药复发或进展的患者,pro-GRP水平升高时间较NSE提前。结论 pro-GRP可能作为SCLC诊断及疗效监测指标。

Clinical significance of pro-gastrin-releasing peptide for diagnosis and prognosis of small-cell lung cancer

Objective?To explore the clinical diagnostic and prognostic significance of pro-gastrin-releasing peptide (pro-GRP) in small-cell lung cancer (SCLC).?Methods?A total of 2 584 patients with lung cancer diagnosed pathologically in the First Hospital of Jilin University from January 2018 to January 2021 were enrolled, including 132 cases of SCLC and 2 452 cases of non-small-cell lung cancer (NSCLC). Pro-GRP levels were measured in electrochemiluminescence immunoassay by Roche Cobas e601. The levels of neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), cytokeratin fragment 19 (CYFAR21-1), squamous cell carcinoma antigen (SCC) and other tumor markers in each group were also measured simultaneously. The receiver operating characteristic curves was used to evaluate the diagnostic efficiency of each tumor marker in single and combined detection of lung cancer. The levels of Pro-GRP and NSE in serum of the 132 SCLC patients were continuously monitored to analyze the consistency of the levels of both Pro-GRP and NSE with prognosis of the patients.?Results?In SCLC patients, median levels of pro-GRP were significantly higher than those of other groups (P<0.05). The area under the ROC curve, sensitivity and specificity of pro-GRP were shown to reach 0.976, 76.6% and 99.7% respectively. Combined detection of multiple markers improved the sensitivity, specificity, positive predictive value, negative predictive value and the total effective rate, which were all higher than the results of relying on a single marker (P<0.05). Among the patients responded effectively to chemotherapy, the serum pro-GRP level after the second cycle of chemotherapy was significantly lower than baseline level (P<0.001). For the patients with relapse or progression due to drug resistance, their increase of pro-GRP level was earlier than the change of NSE.?Conclusion?Pro-GRP may be used as a new tumor marker for diagnosis, prognosis and monitoring for the effects of therapy in SCLC patients.