摘要目的 探讨癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原125(CA125)、神经元烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1)和鳞状细胞癌抗原(SCC)6种血清肿瘤标志物对晚期肺癌患者一线化疗评效及总生存预测的价值.方法 回顾性研究.收集2013年6月至2014年12月,在北京大学肿瘤医院就诊的181例ⅢB～Ⅳ期一线化疗前和化疗2周期后检测过6种肿瘤标志物的所有肺癌患者,其中男133例、女48例,平均年龄58(26 ～ 80)岁.肿瘤标志物采用电化学发光法检测.以基于CT检查的RECISTv1.1评效标准作对照,评价化疗2周期后血清肿瘤标志物浓度与化疗前相比下降≥20％、升高≥20％和下降或升高＜20％判别部分缓解(PR)、疾病进展(PD)、疾病稳定(SD)的敏感度和特异性.采用Kappa一致性检验比较肿瘤标志物变化评效与CT评效的一致性.电话随访患者的总生存期.结果 在腺癌、鳞癌和小细胞肺癌患者,阳性率最高的3种肿瘤标志物分别为CEA、NSE及CA125,CYFRA21-1、NSE及SCC,NSE、CA125及CYFRA21-1.血清CEA、CA125,CYFRA21-1、SCC,NSE的变化分别对于3种不同病理类型肺癌患者PR、SD、PD的辅助诊断与CT存在一致性(P＜0.05),对于3种肺癌化疗PR预测的敏感度均高于90％,特异度只有20％ ～58.3％,对于SD和PD的辅助诊断,具有较好的特异度,但敏感度低(0～66.7％).采用RECISTv1.1标准判别的腺癌PR、SD、PD患者总生存期之间差异无统计学意义(中位生存期17个月vs 22个月vs14个月,P ＞0.05),鳞癌和小细胞肺癌PR患者总生存期显著长于SD和PD患者.6种肿瘤标志物中只有化疗2个周期后血清SCC的变化可预测鳞癌患者的总生存期.结论 肿瘤标志物评价晚期肺癌化疗部分缓解具有较高的敏感度,但对稳定或进展的预测价值有限,联合CT检查利于患者的综合评价.化疗2周期后与基线水平相比血清SCC的变化对于鳞癌患者的生存具有预测价值.

abstractsObjective To investigate the significance of carcinoembryonic antigen (CEA),carbohydrate antigen 19-9 (CA19-9),carbohydrate antigen 125 (CA125),neuron specific enolase (NSE),cytokeratin 19 fragment (CYFRA21-1) and squamous cell carcinoma antigen (SCC) for evaluation of first-line chemotherapeutic response and the prognostic value of these markers for prediction of overall survival (OS) in patients with advanced lung cancer.Methods Patients diagnosed with Ⅲ b/Ⅳ stage untreated,primary lung cancer and received first-line chemotherapy in Peking University Cancer Hospital & Institute from June 2013 to December 2014 were enrolled retrospectively into this study.The results of tumor markers before and after two cycles of chemotherapy and the clinical data of 181 eligible patients,including 133 males and 48 females with the average age of 58 years,were collected.The serum levels of six tumor markers were measured by electrochemiluminescence assay.Using RECISTv1.1 as standard,the sensitivity and specificity of tumor markers in classifying PR,SD,PD,were observed.The Kappa agreement test was used to evaluate the correlation between serum tumor markers and CT in evaluating chemotherapy response.The follow-up of OS was derived by telephone.Results The top three positive rates of biomarkers were CEA,CA125 and NSE in adenocarcinoma patients,CYFRA21-1,NSE and SCC in squamous carcinoma patients,NSE,CA125 and CYFRA21-1 in small cell lung cancer patients,respectively.In Kappa agreement test,the changes of serum levels of CEA and CA125,CYFRA21-1 and SCC,NSE were significantly correlated with CT for chemotherapy response evaluation in the mention above three kinds of carcinomas respectively (P ＜ 0.05).The sensitivity of tumor markers predicting PR was more than 90％,but the specificity was only 20％-58.3％,meanwhile,the specificity for SD and PD was high,but the sensitivity was low 0-66.7％).In the prognostic evaluation based on RECISTv1.1,there was no statistical significance for classifying PR,SD and PD in adenocarcinoma patients (median overall survival 17 months vs 22 months vs 14 months,P ＞0.05),but the OS of PR was longer than SD and PD in squamous and small cell lung carcinoma (median overall survival 28 months vs 22 months vs 4 months,12 months vs 8 months vs 8 months,P ＜ 0.05).Of these six tumor markers,only SCC was of statistical significance for classifying PR,SD and PD in squamous carcinoma (median overall survival 30 months vs 1 1 months vs 4 months,P ＜ 0.05).Conclusions Tumor marker has high sensitivity for predicting PR,but the value of tumor marker predicting SD and PD of advanced lung cancer was limited.The evaluation of patients would be comprehensive by combined use of tumor markers and CT.The changes of SCC after 2 cycles of chemotherapy are predictive of survival in squamous cell carcinoma patients.