Objective: To investigate the diagnostic efficiency of conventional serum tumor markers and their combination with chest CT for stage ⅠA lung cancer. Methods: A total of 1 155 patients with stage ⅠA lung cancer and 200 patients with benign lung lesions (confirmed by surgery) treated at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to October 2020 were retrospectively enrolled in this study. Six conventional serum tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), squamous cell carcinoma associated antigen (SCCA), cytokeratin 19 fragment (CYFRA21-1), neuron-specific enolase (NSE), and gastrin-releasing peptide precursor (ProGRP)] and chest thin-slice CT were performed on all patients one month before surgery. Pathology was taken as the gold standard to analyze the difference of positivity rates of tumor markers between the lung cancer group and the benign group, the moderate/poor differentiation group and the well differentiation group, the adenocarcinoma group and the squamous cell carcinoma group, the lepidic and non-lepidic predominant adenocarcinoma groups, the solid nodule group and the subsolid nodule group based on thin-slice CT, and subgroups of ⅠA1 to ⅠA3 lung cancers. The diagnostic performance of tumor markers and tumor markers combined with chest CT was analyzed using the receiver operating characteristic curve. Results: The positivity rates of six serum tumor markers in the lung cancer group and the benign group were 2.32%-20.08% and 0-13.64%, respectively; only the SCCA positivity rate in the lung cancer group was higher than that in the benign group (10.81% and 0, P=0.022). There were no significant differences in the positivity rates of other serum tumor markers between the two groups (all P>0.05). The combined detection of six tumor markers showed that the positivity rate of the lung cancer group was higher than that of the benign group (40.93% and 18.18%, P=0.004), and the positivity rate of the adenocarcinoma group was lower than that of the squamous cell carcinoma group (35.66% and 47.41%, P=0.045). The positivity rates in the poorly differentiated group and moderately differentiated group were higher than that in the well differentiated group (46.48%, 43.75% and 22.73%, P=0.025). The positivity rate in the non-lepidic adenocarcinoma group was higher than that in lepidic adenocarcinoma group (39.51% and 21.74%, P=0.001). The positivity rate of subsolid nodules was lower than that of solid nodules (30.01% vs 58.71%, P=0.038), and the positivity rates of stageⅠA1, ⅠA2 and ⅠA3 lung cancers were 33.33%, 48.96% and 69.23%, respectively, showing an increasing trend (P=0.005). The sensitivity and specificity of the combined detection of six tumor markers in the diagnosis of stage ⅠA lung cancer were 74.00% and 56.30%, respectively, and the area under the curve (AUC) was 0.541. The sensitivity and specificity of the combined detection of six serum tumor markers with CT in the diagnosis of stage ⅠA lung cancer were 83.0% and 78.3%, respectively, and the AUC was 0.721. Conclusions: For stage ⅠA lung cancer, the positivity rates of commonly used clinical tumor markers are generally low. The combined detection of six markers can increase the positivity rate. The positivity rate of markers tends to be higher in poorly differentiated lung cancer, squamous cell carcinoma, or solid nodules. Tumor markers combined with thin-slice CT showed limited improvement in diagnostic efficiency for early lung cancer.
目的： 探讨临床常用血清肿瘤标志物及联合胸部薄层CT在ⅠA期肺癌诊断中的价值。 方法： 收集2016年1月至2020年10月就诊于中国医学科学院肿瘤医院的ⅠA期肺癌患者1 155例为肺癌组，200例肺部良性结节患者为良性组。术前1个月内均接受6种临床常用血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)、鳞状上皮细胞癌相关抗原(SCCA)、细胞角蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)、胃泌素释放肽前体(ProGRP)]检测和胸部薄层CT扫描。以病理诊断结果为金标准，依次比较肺癌组与良性组、肺癌中低分化组与高分化组、腺癌组与鳞状细胞癌组、腺癌附壁型组与非附壁型组、基于薄层CT的肺实性结节组与亚实性结节组及ⅠA1~A3期肺癌各亚组间的血清肿瘤标志物水平，采用受试者工作特征(ROC)曲线分析血清肿瘤标志物单独及联合CT对ⅠA期肺癌的诊断效能。 结果： 肺癌组6种血清肿瘤标志物单项检测的阳性率在2.32%~20.08%，良性组为0~13.64%，其中仅肺癌组的SCCA阳性率高于良性组(分别为10.81%和0，P＝0.022)，其他血清肿瘤标志物的阳性率两组差异无统计学意义(均P>0.05)。6种肿瘤标志物联合检测，肺癌组的阳性率高于良性组(分别为40.93%和18.18%，P＝0.004)，腺癌组的阳性率低于鳞状细胞癌组(分别为35.66%和47.41%, P＝0.045)，低分化组和中分化组患者的阳性率高于高分化组(分别为46.48%、43.75%和22.73%，P＝0.025)，腺癌非附壁型组的阳性率高于附壁型组(分别为39.51%和21.74%, P＝0.001)，亚实性结节组的阳性率低于实性结节组(分别为30.01%和58.71%，P＝0.038)，ⅠA1期组、ⅠA2期组和ⅠA3期组的阳性率依次为33.33%、48.96%和69.23%，显递增趋势(P＝0.005)。6种肿瘤标志物联合检测诊断ⅠA期肺癌的灵敏度和特异度分别为74.00%和56.30%，ROC曲线下面积(AUC)为0.541。6种血清肿瘤标志物联合检测+CT诊断ⅠA期肺癌的灵敏度和特异度分别为83.0%和78.3%，AUC为0.721。 结论： 对于ⅠA期肺癌，目前临床常用肿瘤标志物的阳性率普遍不高，6种肿瘤标志物联合检测可以提高阳性率。6种肿瘤标志物联合检测的阳性率在中低分化癌、鳞状细胞癌或实性较大结节相对较高。肿瘤标志物检测联合薄层CT对ⅠA期肺癌诊断效能提高有限。.
Keywords: Computed tomography; Diagnosis; Lung neoplasms; Tumor markers.