Department of Dermatology, Ningbo First Hospital, Ningbo, China.
Department of Laboratory Medicine, Ningbo First Hospital, Ningbo, China.
Pathol Oncol Res. 2022 Apr 20;28:1610280. doi: 10.3389/pore.2022.1610280. eCollection 2022.
The diagnostic value of tumor markers in pleural effusion (PE) and serum for malignant pleural effusion (MPE) is still in debate. This study aimed to evaluate the diagnostic value of six tumor markers in PE, serum, and the corresponding PE/serum (PE/S) ratio in distinguishing MPE from benign pleural effusion (BPE). A total of 1,230 patients with PE (452 MPEs and 778 BPEs) were retrospectively included in the study. PE and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA15-3), carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), cytokeratin 19 fragment (CYFRA 21-1), and neuron-specific enolase (NSE) were measured. The area under the curve (AUC) was used to assess the single and combined diagnostic values of the six tumor markers for MPE. The levels of the six tumor markers in PE, serum, and PE/S were significantly higher in MPE than that in BPE, except for serum CA125. PE CEA showed the highest AUC [0.890 (0.871-0.907)] at a cut-off value of 3.7 ng/ml compared to any single tumor marker using receiver operating characteristic (ROC) analysis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of PE CEA were 74.1%, 95.5%, 90.5%, 86.4%, 16.47, and 0.27, respectively. The combination of PE CEA and serum CYFRA21-1 showed the best diagnostic performance with an AUC of 0.934 (sensitivity, 79.9%; specificity, 95.7%, PPV, 90.5; PLR, 17.35) among all two or three combinations. Besides, serum CYFRA21-1 was the best diagnostic tumor marker in distinguishing cytology-negative MPE from BPE at a cut-off value of 3.0 ng/ml. PE CEA was the best diagnostic tumor marker in distinguishing MPE from BPE. Serum CYFRA21-1 was the best diagnostic tumor marker in distinguishing cytology-negative MPE from BPE. The combination of PE CEA and serum CYFRA21-1 could increase the diagnostic performance in distinguishing MPE from BPE and cytology-negative MPE from BPE.
胸腔积液（PE）和血清中肿瘤标志物对恶性胸腔积液（MPE）的诊断价值仍存在争议。本研究旨在评估 6 种肿瘤标志物在 PE、血清和相应的 PE/血清（PE/S）比值中对区分 MPE 与良性胸腔积液（BPE）的诊断价值。共纳入 1230 例胸腔积液患者（452 例 MPE 和 778 例 BPE）进行回顾性研究。测量了癌胚抗原（CEA）、糖链抗原 15-3（CA15-3）、糖链抗原 125（CA125）、糖链抗原 19-9（CA19-9）、细胞角蛋白 19 片段（CYFRA 21-1）和神经元特异性烯醇化酶（NSE）在 PE 和血清中的水平。采用曲线下面积（AUC）评估 6 种肿瘤标志物单独和联合诊断 MPE 的价值。与 BPE 相比，MPE 中 6 种肿瘤标志物在 PE、血清和 PE/S 中的水平均显著升高，除了血清 CA125 外。与任何单一肿瘤标志物相比，使用接收者操作特征（ROC）分析，PE CEA 在 3.7ng/ml 的截断值下具有最高 AUC [0.890（0.871-0.907）]。PE CEA 的特异性、敏感性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（PLR）和阴性似然比（NLR）分别为 74.1%、95.5%、90.5%、86.4%、16.47 和 0.27。PE CEA 和血清 CYFRA21-1 的联合具有最佳的诊断性能，在所有两种或三种组合中，AUC 为 0.934（敏感性，79.9%；特异性，95.7%，PPV，90.5%；PLR，17.35）。此外，在 3.0ng/ml 的截断值下，血清 CYFRA21-1 是区分细胞学阴性 MPE 和 BPE 的最佳诊断肿瘤标志物。PE CEA 是区分 MPE 和 BPE 的最佳诊断肿瘤标志物。血清 CYFRA21-1 是区分细胞学阴性 MPE 和 BPE 的最佳诊断肿瘤标志物。PE CEA 和血清 CYFRA21-1 的联合可提高区分 MPE 和 BPE 以及细胞学阴性 MPE 和 BPE 的诊断性能。
