摘要
目的细胞角蛋白21-1片段(CYFRA21-1)、糖链抗原125(CA125)及外周血循环DNA(cf-DNA)与晚期肿瘤患者化疗疗效的相关性研究。方法选取2018年4月至2020年4月间阳煤集团总医院收治的98例晚期肿瘤患者作为研究对象。其中,宫颈癌28例纳入宫颈癌组,胃癌38例纳入胃癌组,肺癌32例纳入肺癌组。另选取同期30例健康受检者纳入健康组。比较各组癌胚抗原(CEA)、CYFRA21-1、鳞状上皮细胞癌抗原(SCC)、糖链抗原19-9(CA19-9)、CA125和外周血cf-DNA水平变化。分析外周血cf-DNA水平与临床病理参数的关系。对晚期实体瘤患者治疗2个周期后参照影像学结果进行疗效评价,并对不同化疗周期后cf DNA浓度变化与影像学疗效评价的关系进行分析。建立受试者工作曲线(ROC),分析外周血cf-DNA水平及相关肿瘤标记物与晚期实体瘤预后的关系。结果与健康组比较,肺癌组、宫颈癌组及胃癌组的血清CYFRA21-1、CEA、SCC、CA19-9、CA125和外周血cf-DNA水平均升高,差异均有统计学意义(均P<0.05)。外周血cf-DNA水平与临床分期及是否伴有转移相关,差异均有统计学意义(均P<0.05),而外周血cf-DNA水平与年龄、性别、分化程度、病理类型及吸烟等不相关,差异无统计学意义(P>0.05)。化疗2个周期后,剩余88例。经化疗后无完全缓解患者,化疗2个周期后,部分缓解、疾病稳定、疾病进展分别为12例(13.6%)、52例(29.1%)、24例(27.3%)。不同化疗周期后cf DNA水平变化与影像学疗效评价明显相关,差异均有统计学意义(均P<0.05)。建立ROC曲线发现,cf-DNA水平、CYFRA21-1、CEA、SCC、CA19-9和CA125的曲线下面积分别为0.859、0.774、0.817、0.735、0.786和0.651,CYFRA21-1、CA125水平在晚期癌症预后诊断中特异性较高,而cf-DNA水平在晚期实体瘤的预后诊断中灵敏度及特异度均较高。结论CYFRA21-1、CA125及外周血cf-DNA检测可作为判断晚期肿瘤患者化疗疗效及预后评估的重要指标。
Objective To study the association between cytokeratin 21-1 fragment(CYFRA21-1),cancer antigen 125(CA125)and circulating DNA(cf DNA)and efficacy of chemotherapy in patients with advanced cancer.Methods Ninety-eight patients with advanced cancer who were treated at General Hospi-tal of Shanxi Yangquan Coal Group were randomly selected from April 2018 to April 2020.Of them,32 pa-tients with lung cancer were included in a lung cancer group,28 patients with cervical cancer were included in a cervical cancer group and 38 patients with gastric cancer were included in a gastric cancer group.An-other 30 healthy individuals who had physical examination in the same period were included in a healthy group.Changes in the levels of carcinoembryonic antigen(CEA),CYFRA21-1,squamous cell carcinoma antigen(SCC),carbohydrate antigen 19-9(CA19-9),CA125 and cf DNA in peripheral blood were compared among these groups.The relationship between the level of cf DNA in peripheral blood and clinical parameters was analyzed.The therapeutic effect after chemotherapy of 2 cycles was evaluated based on the imaging re-sults,and the relationship was analyzed between the changes in cf DNA concentration after different cycles of chemotherapy and the imaging evaluation.A receiver operating curve(ROC)curve was established to analyze the relationship between the level of cf DNA in peripheral blood and the prognosis of advanced solid tumors.Results Compared with the healthy group,the levels of CYFRA21-1,CEA,SCC,CA19-9,CA125 and cf D-NA in peripheral blood were significantly increased in the lung cancer group,cervical cancer group and gastric cancer group(all P<0.05).The level of cf DNA in peripheral blood was significantly associated with clinical stage and metastasis(all P<0.05)rather than with age,gender,differentiation degree,pathological type and smoking(P>0.05).After chemotherapy of 2 cycles,88 patients remained compliance with the study.After 2 cycles of chemotherapy,no complete response occurred,partial response(PR)occurred in 12 patients(13.6%),stable diseased occurred(SD)in 52 patients(29.1%)and progressive disease(PD)occurred in 24 patients(27.3%).The change in cf DNA level after different chemotherapy cycles was significantly as-sociated with imaging evaluation(all P<0.05).The area under the curve 0.859,0.774,0.817,0.735,0.786 and 0.651,respectively for cf DNA,CYFRA21-1,CEA,SCC,CA19-9 and CA125.The specificity of CYFRA21-1 and CA125 was higher for the prognosis of advanced cancer,and both the sensitivity and specific-ity of cf DNA were higher for the prognosis of advanced solid tumors.Conclusion The detection of CY-FRA21-1,CA125 and cf DNA in peripheral blood can be used as an important index to evaluate the chemo-therapy efficacy and prognosis of patients with advanced cancer.
作者
李力
温化冰
王雪芹
崔素平
田月霞
王琦
LI Li;WEN Hua-bing;WANG Xue-qin;CUI Su-ping;TIAN Yue-xia;WANG Qi(Department of Oncology,General Hospital of Shanxi Yangquan Coal Group,Yangquan 045000,China)
出处
《中国肿瘤临床与康复》
2021年第10期1238-1242,共5页
Chinese Journal of Clinical Oncology and Rehabilitation
基金
山西省阳泉市重点研发计划项目(2018S0202)。
