Wang Xin-Feng, Wu Yan-Hua, Wang Mao-Shui, Wang Yun-Shan
Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China E-mail :
Asian Pac J Cancer Prev. 2014;15(1):363-8. doi: 10.7314/apjcp.2014.15.1.363.
Determination of the cause of malignant pleural effusions is important for treatment and management, especially in cases of unknown primaries. There are limited biomarkers available for prediction of the cause of malignant pleural effusion in clinical practice. Hence, we evaluated pleural levels of five tumor biomarkers (CEA, AFP, CA125, CA153 and CA199) in predicting the cause of malignant pleural effusion in a retrospective study. Kruskal-Wallis or Mann-Whitney U tests were carried out to compare levels of tumor markers in pleural effusion among different forms of neoplasia - lung squamous cell carcinoma, adenocarcinoma, or small cell carcinoma, mesothelioma, breast cancer, lymphoma/leukemia and miscellaneous. Receiver operator characteristic analysis was performed to evaluate sensitivity and specificity of biomarkers. The Kruskal-Wallis test showed significant differences in levels of pleural effusion CEA (P<0.01), AFP (P<0.01), CA153 (P<0.01) and CA199 (P<0.01), but not CA125 (P>0.05), among the seven groups. Receiver operator characteristic analysis showed that, compared with other four tumor markers, CA153 was the best biomarker in diagnosing malignant pleural effusions of lung adenocarcinoma (area under curve (AUC): 0.838 (95%confidence interval: 0.787, 0.888); cut-off value: 10.2U/ ml; sensitivity: 73.2% (64.4-80.8)%, specificity: 85.2% (77.8-90.8)%), lung squamous cell carcinoma (AUC: 0.716 (0.652, 0.780); cut-off value: 14.2U/ml; sensitivity: 57.6% (50.7-64.3)%, specificity: 91.2% (76.3-98.0)%), and small-cell lung cancer (AUC: 0.812 (0.740, 0.884); cut-off value: 9.7U/ml; sensitivity: 61.5% (55.0-67.8)%, specificity: 94.1% (71.2-99.0)%); CEA was the best biomarker in diagnosing MPEs of mesothelioma (AUC: 0.726 (0.593, 0.858); cut-off value: 1.43ng/ml; sensitivity: 83.7% (78.3-88.2)%, specificity: 61.1% (35.8-82.6)%) and lymphoma/leukemia (AUC: 0.923 (0.872, 0.974); cut-off value: 1.71ng/ml; sensitivity: 82.8% (77.4-87.3)%, specificity: 92.3% (63.9-98.7)%). Thus CA153 and CEA appear to be good biomarkers in diagnosing different causes of malignant pleural effusion. Our findings implied that the two tumor markers may improve the diagnosis and treatment for effusions of unknown primaries.
确定恶性胸腔积液的病因对于治疗和管理至关重要，尤其是在原发性肿瘤不明的情况下。在临床实践中，可用于预测恶性胸腔积液病因的生物标志物有限。因此，我们在一项回顾性研究中评估了五种肿瘤生物标志物（癌胚抗原、甲胎蛋白、糖类抗原125、糖类抗原153和糖类抗原199）在胸腔中的水平，以预测恶性胸腔积液的病因。采用Kruskal-Wallis检验或Mann-Whitney U检验来比较不同类型肿瘤（肺鳞状细胞癌、腺癌、小细胞癌、间皮瘤、乳腺癌、淋巴瘤/白血病及其他）胸腔积液中肿瘤标志物的水平。进行受试者工作特征分析以评估生物标志物的敏感性和特异性。Kruskal-Wallis检验显示，七组之间胸腔积液中癌胚抗原（P<0.01）、甲胎蛋白（P<0.01）、糖类抗原153（P<0.01）和糖类抗原199（P<0.01）水平存在显著差异，但糖类抗原125水平无显著差异（P>0.05）。受试者工作特征分析表明，与其他四种肿瘤标志物相比，糖类抗原153是诊断肺腺癌恶性胸腔积液的最佳生物标志物（曲线下面积（AUC）：0.838（95%置信区间：0.787，0.888）；临界值：10.2U/ml；敏感性：73.2%（64.4-80.8）%，特异性：85.2%（77.8-90.8）%）、肺鳞状细胞癌（AUC：0.716（0.652，0.780）；临界值：14.2U/ml；敏感性：57.6%（50.7-64.3）%，特异性：91.2%（76.3-98.0）%）和小细胞肺癌（AUC：0.812（0.740，0.884）；临界值：9.7U/ml；敏感性：61.5%（55.0-67.8）%，特异性：94.1%（71.2-99.0）%）；癌胚抗原是诊断间皮瘤（AUC：0.726（0.593，0.858）；临界值：1.43ng/ml；敏感性：83.7%（78.3-88.2）%，特异性：61.1%（35.8-82.6）%）和淋巴瘤/白血病（AUC：0.923（0.872，0.974）；临界值：1.71ng/ml；敏感性：82.8%（77.4-87.3）%，特异性：92.3%（63.9-98.7）%）恶性胸腔积液的最佳生物标志物。因此，糖类抗原153和癌胚抗原似乎是诊断不同病因恶性胸腔积液的良好生物标志物。我们的研究结果表明，这两种肿瘤标志物可能会改善原发性不明胸腔积液的诊断和治疗。
