胸腔积液与血清癌胚抗原比值及差值对恶性胸腔积液的诊断准确性：来自两个队列的研究结果。
Diagnostic accuracy of pleural fluid to serum carcinoembryonic antigen ratio and delta value for malignant pleural effusion: findings from two cohorts.
机构信息
The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
Department of Medical Experiment Center, The College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China.
出版信息
Ther Adv Respir Dis. 2023 Jan-Dec;17:17534666231155745. doi: 10.1177/17534666231155745.
BACKGROUND
Pleural fluid (PF) carcinoembryonic antigen (CEA) is a widely used diagnostic marker for malignant pleural effusion (MPE). Recent studies revealed that PF to serum CEA was also a promising diagnostic parameter for MPE.
OBJECTIVE
We aimed to investigate whether PF to serum CEA ratio and delta CEA (PF minus serum CEA) provided added value to PF CEA in diagnosing MPE.
METHODS
Patients with pleural effusion in a retrospective cohort (BUFF) and a prospective cohort (SIMPLE) were included. The clinical characteristics of the patients were extracted from their medical records. The diagnostic value of CEA ratio and delta CEA was estimated by a receiver operating characteristics (ROC) curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
RESULTS
A total of 148 patients in the BUFF cohort and 164 patients in the SIMPLE cohort were enrolled. The BUFF cohort had 46 MPE patients and 102 benign pleural effusion (BPE) patients, and the SIMPLE cohort had 85 MPE patients and 79 BPE patients. In both cohorts, MPE patients had significantly higher PF CEA, serum CEA, CEA ratio, and delta CEA. The area under ROC curves (AUCs) of PF CEA, CEA ratio, and delta CEA were 0.78 (95% CI: 0.67-0.88), 0.80 (95% CI: 0.72-0.89) and 0.83 (95% CI: 0.75-0.91) in the BUFF cohort, and 0.89 (95% CI: 0.83-0.94), 0.86 (95% CI: 0.80-0.92), and 0.84 (95% CI: 0.78-0.91) in the SIMPLE cohort. The differences between the AUCs of PF CEA, CEA ratio, and delta CEA did not reach statistical significance. The continuous NRI and IDI of CEA ratio and delta CEA were <0.
CONCLUSION
CEA ratio and delta value cannot provide added diagnostic value to PF CEA. The simultaneous determination of serum and PF CEA should not be adopted in clinical practice.
背景
胸腔积液（PF）癌胚抗原（CEA）是一种广泛用于诊断恶性胸腔积液（MPE）的诊断标志物。最近的研究表明，PF 与血清 CEA 的比值和 delta CEA（PF 减去血清 CEA）也是诊断 MPE 的有前途的诊断参数。
目的
我们旨在研究 PF 与血清 CEA 的比值和 delta CEA 是否为 PF CEA 在诊断 MPE 方面提供了附加价值。
方法
本研究纳入了回顾性队列（BUFF）和前瞻性队列（SIMPLE）中的胸腔积液患者。从病历中提取患者的临床特征。通过受试者工作特征（ROC）曲线、净重新分类改善（NRI）和综合判别改善（IDI）来评估 CEA 比值和 delta CEA 的诊断价值。
结果
共纳入了 148 例 BUFF 队列患者和 164 例 SIMPLE 队列患者。BUFF 队列中有 46 例 MPE 患者和 102 例良性胸腔积液（BPE）患者，SIMPLE 队列中有 85 例 MPE 患者和 79 例 BPE 患者。在两个队列中，MPE 患者的 PF CEA、血清 CEA、CEA 比值和 delta CEA 均显著升高。在 BUFF 队列中，PF CEA、CEA 比值和 delta CEA 的 ROC 曲线下面积（AUC）分别为 0.78（95%CI：0.67-0.88）、0.80（95%CI：0.72-0.89）和 0.83（95%CI：0.75-0.91），在 SIMPLE 队列中，其 AUC 分别为 0.89（95%CI：0.83-0.94）、0.86（95%CI：0.80-0.92）和 0.84（95%CI：0.78-0.91）。PF CEA、CEA 比值和 delta CEA 的 AUC 之间的差异无统计学意义。CEA 比值和 delta CEA 的连续 NRI 和 IDI 均<0。
结论
CEA 比值和 delta 值不能为 PF CEA 提供附加诊断价值。在临床实践中不应同时测定血清和 PF CEA。
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