Otoshi Takehiro, Kataoka Yuki, Ikegaki Shunkichi, Saito Emiko, Matsumoto Hirotaka, Kaku Sawako, Shimada Masatoshi, Hirabayashi Masataka
Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan.
PLoS One. 2017 Oct 2;12(10):e0185850. doi: 10.1371/journal.pone.0185850. eCollection 2017.
In this study, we aimed to examine the clinical value of the pleural effusion (PE) biomarkers, soluble mesothelin-related peptide (SMRP), cytokeratin 19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA), and the utility of combining chest computed tomography (CT) findings with these biomarkers, in diagnosing malignant pleural mesothelioma (MPM). We conducted a retrospective cohort study in a single center. Consecutive patients with undiagnosed pleural effusions who underwent PE analysis between September 2014 and August 2016 were reviewed. This study included 240 patients (32 with MPM and 208 non-MPM). SMRP and the CYFRA 21-1/CEA ratio had a sensitivity and specificity for diagnosing MPM of 56.3% and 86.5%, and 87.5% and 74.0%, respectively. Using receiver operating characteristics (ROC) curve analysis of the ability of these markers to distinguish MPM from all other PE causes, the area under the ROC curve (AUC) for SMRP and the CYFRA 21-1/CEA ratio was 0.804 and 0.874, respectively. The sensitivity and specificity of SMRP combined with the CYFRA 21-1/CEA ratio were 93.8% and 64.9%, respectively. The sensitivity of the combination of SMRP, the CYFRA 21-1/CEA ratio, and the presence of Leung's criteria (a chest CT finding that is suggestive of malignant pleural disease) was 93.8%. In conclusion, the combined PE biomarkers had a high sensitivity for diagnosing MPM, although the addition of chest CT findings did not improve the sensitivity of SMRP combined with the CYFRA 21-1/CEA ratio. Combination of these biomarkers helped to rule out MPM effectively among patients at high risk of suffering MPM and would be valuable especially for old frail patients who have difficulty in undergoing invasive procedures such as thoracoscopy.
在本研究中，我们旨在探讨胸腔积液（PE）生物标志物可溶性间皮素相关肽（SMRP）、细胞角蛋白19片段（CYFRA 21-1）和癌胚抗原（CEA）的临床价值，以及将胸部计算机断层扫描（CT）结果与这些生物标志物相结合在诊断恶性胸膜间皮瘤（MPM）中的效用。我们在单一中心进行了一项回顾性队列研究。对2014年9月至2016年8月期间接受PE分析的连续未确诊胸腔积液患者进行了回顾。本研究纳入了240例患者（32例MPM患者和208例非MPM患者）。SMRP以及CYFRA 21-1/CEA比值诊断MPM的敏感性和特异性分别为56.3%和86.5%，以及87.5%和74.
0%。通过对这些标志物区分MPM与所有其他PE病因能力的受试者工作特征（ROC）曲线分析，SMRP以及CYFRA 21-1/CEA比值的ROC曲线下面积（AUC）分别为0.804和0.874。SMRP与CYFRA 21-1/CEA比值联合使用时的敏感性和特异性分别为93.8%和64.9%。SMRP、CYFRA 21-1/CEA比值以及存在梁氏标准（一种提示恶性胸膜疾病的胸部CT表现）联合使用时的敏感性为93.8%。总之，联合PE生物标志物对诊断MPM具有较高的敏感性，尽管添加胸部CT结果并未提高SMRP与CYFRA 21-1/CEA比值联合使用时的敏感性。这些生物标志物的联合有助于在MPM高危患者中有效排除MPM，尤其对于难以接受胸腔镜等侵入性检查的老年体弱患者具有重要价值。
