多肿瘤标志物诊断模型对老年非小细胞肺癌胸膜转移的临床诊断研究

目的比较不同肿瘤标志物对老年非小细胞肺癌(NSCLC)胸膜转移的诊断价值,并筛选最佳诊断效能标志物及标志物组合。方法选取我院内科胸腔镜诊断为NSCLC胸膜转移的老年病人60例为肺癌组,另选取同期各类良性胸腔积液病人49例为对照组。检测2组病人胸腔积液中的癌胚抗原(CEA)、细胞角质蛋白19片段(CYFRA21-1)、神经烯醇化酶(NSE)、糖类抗原(CA)125、CA199、CA153的表达水平。采用Logistic逐步回归法纳入2组间差异有统计学意义的肿瘤标志物并建立函数诊断模型,进行预测分类、串联诊断试验及绘制受试者工作特征曲线等方法筛选出诊断效能最佳的标志物及标志物组合。结果2组间CEA、CYFRA21-1、NSE、CA125、CA199、CA153的表达水平差异均有统计学意义(P<0.05或P<0.01)。经Logistic多元回归分析筛选出评分较高的5种标志物串联组成的诊断模型为:CEA+NSE+CYFRA21.1、CYFRA21.1+NSE+CA125、CEA+CYFRA21.1+CA199、CEA+NSE+CA125+CA199及NSE+CYFRA21.1+CA125+CA199,其中CYFRA21.1+NSE+CA125具有更高的诊断效能。结论胸腔积液肿瘤标志物检测对NSCLC的胸膜转移有定性诊断价值,由标志物串联组成的诊断模型对胸膜转移恶性胸腔积液有临床辅助诊断价值,可为老年晚期肺癌病人提供无创、特异的诊断方法。

Clinical diagnosis of pleural metastasis in elderly patients with non-small cell lung cancer using different tumor marker diagnostic model

Objective To compare the diagnostic value of tumor markers for pleural metastasis in the elderly patients with non-small cell lung cancer ( NSCLC) and to screen the best marker combinations. Methods Sixty cases of elderly patients with NSCLC pleural metastasis diagnosed by thoracoscopy in hospital were selected as the lung cancer group, and other 49 patients with benign pleural effusion in the same period were selected as the control group. The expressions of carcinoembryonic antigen (CEA), keratin 19 fragment (CYFRA21-1), neuroenolase (NSE), carbohydrate antigen (CA)125, CA199, CA153 in pleural effusion of two groups were detected. Logistic stepwise regression was used to establish a functional diagnostic model for tumor markers. Redictive classification, serial diagnostic test, and receiver operating characteristic curves were used to screen the best combination of markers for diagnosis. Results There were significant differences in the levels of CEA, CYFRA21-1, NSE, CA125, CA199, CA153 between the two groups ( P< 0.05 or P< 0.01). Logistic multiple regression analysis showed the diagnostic models of the five markers in series: CEA+NSE+CYFRA21-1, CYFRA21-1+ NSE + CA125, CEA + CYFRA21-1 + CA199, CEA + NSE + CA125 + CA199 and NSE + CYFRA21-1+CA125+CA199. Among them, NSE+CYFRA21-1+CA125 had higher diagnostic efficiency. Conclusions Tumor markers have quantitative diagnostic value for the pleural metastasis of NSCLC. The diagnostic model consisting of markers in series has practical value in diagnosis of pleural metastasis. It can provide non-invasive and specific diagnostic methods for the elderly patients with advanced lung cancer.