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肺癌血清标志物的诊断特征和临床应用的新见解,人附睾蛋白 4 作为一种新的标志物?

New insights into the diagnostic characteristics and clinical application of serum biomarkers for lung cancer, and human epididymis protein 4 as a new biomarker?

机构信息

Department of Laboratory Diagnostics, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.

Department of Laboratory Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China.

出版信息

Neoplasma. 2022 May;69(3):729-740. doi: 10.4149/neo_2022_220207N144. Epub 2022 Apr 26.

Abstract

The value of serum tumor biomarkers used for lung cancer diagnosis is still controversial in clinical practice. This study aimed to further dissect and evaluate the clinical value of serum progastrin-releasing peptide (ProGRP), neuron-specific enolase (NSE), squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), cytokeratin-19 fragment (CYFRA21-1) together with a potential new biomarker, the human epididymis protein 4 (HE4) for lung cancer diagnosis, in a large cohort of a Chinese population. Ostensibly healthy individuals, as well as those with benign non-cancerous diseases, benign tumors, lung cancers, and other types of malignancies, were enrolled in the study. Serum ProGRP, NSE, SCC-Ag, CEA, CYFRA21-1, and HE4 were analyzed using the chemiluminescence immunoassay. Data were analyzed utilizing the SPSS and GraphPad Prism software. Detailed dissection of the diagnostic characteristics of serum 6 biomarkers on lung cancer was performed. All 6 biomarkers showed capabilities in characterizing lung cancer from other diseases. ProGRP and NSE were highly specific to small cell lung cancer (SCLC); SCC-Ag was a fair biomarker for NSCLC, specifically SCC histotype; CEA showed specificity to SCLC, followed by NSCLC; CYFRA21-1 was a good biomarker for both SCLC and NSCLC; HE4 showed high specificity to SCLC. For NSCLC characterization, CYFRA21-1+HE4+CEA was the best combinatory pattern in the terms of diagnostic performance (AUC=0.8110). The best combinatory analysis for SCLC was ProGRP+NSE+HE4 (AUC=0.9282). Patients with advanced stage, larger tumor, males, and age 50 or older had higher serum biomarkers levels than those with early stage, smaller tumor, females, and age under 50. Six biomarkers had capabilities in characterizing lung cancer with high or fair diagnostic performance. HE4 is a potential biomarker for both SCLC and NSCLC diagnosis, which merits further investigation.

摘要

血清肿瘤标志物在肺癌诊断中的价值在临床实践中仍存在争议。本研究旨在进一步剖析和评估血清胃泌素释放肽前体(ProGRP)、神经元特异性烯醇化酶(NSE)、鳞状细胞癌抗原(SCC-Ag)、癌胚抗原(CEA)、细胞角蛋白 19 片段(CYFRA21-1)和一个潜在的新生物标志物——人附睾蛋白 4(HE4)在一个中国人群大样本中的临床价值。本研究纳入了看似健康的个体以及患有良性非癌性疾病、良性肿瘤、肺癌和其他类型恶性肿瘤的个体。采用化学发光免疫分析法检测血清 ProGRP、NSE、SCC-Ag、CEA、CYFRA21-1 和 HE4。使用 SPSS 和 GraphPad Prism 软件对数据进行分析。对血清 6 种标志物在肺癌诊断中的特征进行了详细剖析。所有 6 种标志物均具有区分肺癌与其他疾病的能力。ProGRP 和 NSE 对小细胞肺癌(SCLC)具有高度特异性;SCC-Ag 是 NSCLC,特别是 SCC 组织类型的良好标志物;CEA 对 SCLC 具有特异性,随后是 NSCLC;CYFRA21-1 是 SCLC 和 NSCLC 的良好标志物;HE4 对 SCLC 具有高度特异性。对于 NSCLC 特征,CYFRA21-1+HE4+CEA 在诊断性能(AUC=0.8110)方面是最佳组合模式。SCLC 的最佳组合分析是 ProGRP+NSE+HE4(AUC=0.9282)。晚期、肿瘤较大、男性和 50 岁或以上的患者的血清标志物水平高于早期、肿瘤较小、女性和 50 岁以下的患者。6 种标志物具有高或良好的诊断性能,可用于肺癌特征的描绘。HE4 是 SCLC 和 NSCLC 诊断的潜在标志物,值得进一步研究。

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