Zhai Kan, Wang Wen, Wang Yao, Liu Jing-Yuan, Zhou Qiong, Shi Huan-Zhong
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
Medical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
J Thorac Dis. 2017 Dec;9(12):5220-5229. doi: 10.21037/jtd.2017.11.62.
The utility of tumor markers (TMs) for differentiating malignant pleural effusion (MPE) from benign pleural effusion (BPE) has been a subject of controversy. The majority of published studies are single center designed and lack validation. We performed a derivation and validation study in China to evaluate the diagnostic value of carcinoembryonic antigen (CEA) as well as carbohydrate antigen (CA) 15-3, CA 19-9 and CA 125 to differentiate between MPE and BPE.
Three hundred and twenty seven pleural effusion (PE) and paired serum samples were collected from consecutive patients with MPE or BPE in Beijing (174 patients, derivation) and Wuhan (153 patients, validation) during the same period. The concentrations of four TMs were tested using chemiluminescent microparticle immunoassay technology. The performance of the TMs was analyzed by standard receiver operating characteristic (ROC) curves.
The levels of four TMs were significantly higher in MPE than in BPE and the corresponding serum. The concentrations of CEA and CA 15-3 were more stable than the concentrations of CA 125 and CA 19-9. CEA was the best single marker for discriminating MPE from BPE. With a specificity of 100% in the total population, the highest sensitivity (37.8%) using serum was found in CEA. In addition, CEA presented 19.8% sensitivity in PE and 18.0% sensitivity in the Δ(PE-serum). For CA 15-3, the sensitivity was 32.4% in PE, 15.3% in the PE/serum ratio and 25.2% in the Δ(PE-serum).
CEA and CA 15-3 rather than CA 125 and CA 19-9 are more reliable to differentiate between MPE and BPE. The use of the Δ(PE-serum) value in TMs, such as CEA and CA 15-3, may improve the sensitivity and specificity of the diagnosis etiology of PE.
肿瘤标志物（TMs）用于鉴别恶性胸腔积液（MPE）与良性胸腔积液（BPE）的效用一直存在争议。大多数已发表的研究为单中心设计且缺乏验证。我们在中国进行了一项推导和验证研究，以评估癌胚抗原（CEA）以及糖类抗原（CA）15-3、CA 19-9和CA 125鉴别MPE和BPE的诊断价值。
同期从北京（174例患者，推导组）和武汉（153例患者，验证组）连续的MPE或BPE患者中收集327份胸腔积液（PE）及配对血清样本。采用化学发光微粒子免疫分析技术检测四种TMs的浓度。通过标准的受试者工作特征（ROC）曲线分析TMs的性能。
四种TMs在MPE中的水平显著高于BPE及相应血清中的水平。CEA和CA 15-3的浓度比CA 125和CA 19-9的浓度更稳定。CEA是鉴别MPE和BPE的最佳单一标志物。在总人群中特异性为100%时，血清中CEA的灵敏度最高（37.8%）。此外，CEA在PE中的灵敏度为19.8%，在Δ（PE-血清）中的灵敏度为18.0%。对于CA 15-3，其在PE中的灵敏度为32.4%，在PE/血清比值中的灵敏度为15.3%，在Δ（PE-血清）中的灵敏度为25.2%。
CEA和CA 15-3而非CA 125和CA 19-9在鉴别MPE和BPE方面更可靠。在CEA和CA 15-3等TMs中使用Δ（PE-血清）值可能会提高PE诊断病因的灵敏度和特异性。
