肿瘤标志物角蛋白K18、K19与CEA联合检测对肺占位病变良恶性鉴别诊断的意义

目的:评价肿瘤标志物角蛋白18、19(K18、K19)与癌胚抗原(CEA)联合应用对肺占位病变的良恶性鉴别诊断价值。方法:针对150例因肺占位在北京协和医院鉴别病变性质或肿瘤分期行FDG PET/CT显像的初诊患者,血清检测肿瘤标志物K18、K19和CEA。参照医学信息随访数据,将受检患者分为肿瘤组和非肿瘤组,比较K18、K19及CEA单独和联合在肺占位良恶性鉴别诊断中的临床意义。结果:①肿瘤组82例的K18、K19及CEA血清浓度均高于非肿瘤组68例(P<0.01);②晚期(III,IV期)肿瘤中的血清K18,K19,CEA均值都高于早期组(I,II期)(P<0.05)。③K18、K19和CEA对肺癌敏感性分别为25.6%、39%和47.6%,特异度分别为98.5%、83.8%和92.6%。K19和CEA联用,使肺癌检测敏感性明显提高,达65.9%。④K18、K19和CEA对临床I,II期肺癌敏感性分别为2.9%、29.4%和29.4%,K19与CEA联合应用对于临床I,II期肺癌的敏感性显著提高到47.1%。⑤K19对鳞癌的检测阳性率明显高于腺癌,而K18和CEA对腺癌的阳性检出率高于鳞癌。结论:肿瘤标志物角蛋白19针对肺鳞癌的检出率高;在肺占位的良恶性鉴别诊断中,与CEA联用,具有突出的互补性;而且,K19和CEA可共同提高早期肺癌的检测阳性率。

Combination of Cytokeratin Monoclonal Antibodies K18,K19 with CEA in differentiating the lung cancer from benign lesions

Objective:To explore the value of combination of cytokeratin monoclonal antibodies(MAbs) K18,K19 with CEA in differentiating lung cancer from benign lesions.Methods:During April~August 2011,150 patients with lung nodules or masses who performed FDG PET/CT for diagnosis or staging in PeKing Union Medical College Hospital were selected for serum detection of K18,K19 and CEA at the same time.According to pathological result and clinical follow-up,these patients were divided into 2 groups:tumor group and non-tumor group.The value of alone and combination use of K18,K19 and CEA for differentiating lung cancer from benign lesions were evaluated.Results:① Serum K18,K19 and CEA levels in tumor group were all significantly higher than those in non-tumor group(P<0.01).② Serum K18,K19 and CEA levels in patients with advanced lung cancer were all higher than those in patients with early lung cancer.③ sensitivities of K18,K19 and CEA alone for detecting lung cancer were 25.6%,39% and 47.6% respectively,while the specificities of K18,K19 and CEA alone for detecting lung cancer were 98.5%,83.8% and 92.6% respectively.The combination use of K19 with CEA can make the sensitivity of detecting lung cancer increase to 65.9%.④ Sensitivities of K18,K19 and CEA alone for detecting early lung cancer(stage I,II) were 2.9%,29.4% and 29.4% respectively.The combination use of K19 with CEA can make the sensitivity of detecting early lung cancer increase to 47.1%.⑤ The positive rate of K19 for detecting lung squamous carcinoma was significantly higher than that for lung adenocarcinoma,while the positive rates of both K18 and CEA for detecting lung adenocarcinoma were higher than those for lung squamous carcinoma.Conclusion:K19 is complementary to CEA in detecting lung cancer due to its high positive rate in lung squamous carcinoma.Combined use of K19 and CEA could elevate the positive rate for detecting lung cancer,especially in early stage.