Lv Hongjuan, Luo Ping, Wang Jiahe, Chen Chen, Guo Yuanyuan, Li Yanhong
Department of Respiratory and Critical Care Medicine, The Fourth Hospital of Daqing City Daqing 163453, Heilongjiang, China.
Department of Critical Care Medicine, The Fourth Hospital of Daqing City Daqing 163453, Heilongjiang, China.
Am J Transl Res. 2025 Apr 15;17(4):2712-2720. doi: 10.62347/TAEI9443. eCollection 2025.
OBJECTIVE: To investigate the clinical value of serum tumor markers - carcinoembryonic antigen (CEA), endothelial cell-specific molecule-1 (ESM-1), neuron-specific enolase (NSE), and cytokeratin 19 fragment (CYFRA21-1) - in the diagnosis of lung cancer, and to evaluate the role of preoperative imaging in lung cancer diagnosis. METHODS: A total of 56 lung cancer patients, diagnosed at The Fourth Hospital of Daqing City between January 2022 and December 2023, were included in the lung cancer group. Additionally, 69 patients with benign pulmonary tumors diagnosed during the same period were included in the benign tumor group. Preoperative peripheral serum levels of CEA, CYFRA21-1, NSE, and ESM-1 were compared between the two groups. The expression profiles of these biomarkers were further analyzed, focusing on their correlation with TNM staging, lymph node metastasis, and tumor differentiation. Receiver operating characteristic (ROC) curves were plotted to assess the diagnostic performance of these biomarkers. Imaging characteristics were also compared between the two groups to identify features indicative of lung cancer. RESULTS: Serum levels of CYFRA21-1, CEA, ESM-1, and NSE were significantly higher in the lung cancer group compared to the benign tumor group (all P < 0.05). Pathological analysis revealed that these markers were notably associated with low to medium tumor differentiation, lymph node metastasis, and advanced stage (III-IV) (all P < 0.05). Additionally, small cell lung cancer patients exhibited higher positive rates of CYFRA21-1 and elevated levels of CEA, ESM-1, and NSE compared to non-small cell lung cancer patients. ROC curve analysis demonstrated AUC values of 0.878, 0.778, 0.773, and 0.654 for CYFRA21-1, CEA, ESM-1, and NSE, respectively. Imaging features, including spiculated margins, lobulation, pleural retraction, vascular convergence, vacuolar signs, and larger nodule size, were more prevalent in lung cancer patients and were identified as independent risk factors for lung cancer. CONCLUSION: Peripheral serum biomarkers, including CYFRA21-1, CEA, ESM-1, and NSE, demonstrate significant diagnostic potential for lung cancer. Furthermore, imaging characteristics provide valuable insights for distinguishing lung cancer, underscoring the clinical applicability of both diagnostic approaches.
目的：探讨血清肿瘤标志物——癌胚抗原（CEA）、内皮细胞特异性分子-1（ESM-1）、神经元特异性烯醇化酶（NSE）和细胞角蛋白19片段（CYFRA21-1）在肺癌诊断中的临床价值，并评估术前影像学检查在肺癌诊断中的作用。 方法：将2022年1月至2023年12月在大庆市第四医院确诊的56例肺癌患者纳入肺癌组。另外，将同期诊断为良性肺肿瘤的69例患者纳入良性肿瘤组。比较两组患者术前外周血中CEA、CYFRA21-1、NSE和ESM-1的血清水平。进一步分析这些生物标志物的表达谱，重点关注它们与TNM分期、淋巴结转移和肿瘤分化的相关性。绘制受试者工作特征（ROC）曲线以评估这些生物标志物的诊断性能。还比较了两组的影像学特征，以确定提示肺癌的特征。 结果：肺癌组血清CYFRA21-1、CEA、ESM-1和NSE水平明显高于良性肿瘤组（均P<0.05）。病理分析显示，这些标志物与低至中度肿瘤分化、淋巴结转移和晚期（III-IV期）显著相关（均P<0.05）。此外，与非小细胞肺癌患者相比，小细胞肺癌患者CYFRA21-1阳性率更高，CEA、ESM-1和NSE水平升高。ROC曲线分析显示，CYFRA21-1、CEA、ESM-1和NSE的AUC值分别为0.878、0.778、0.773和0.654。包括毛刺边缘、分叶、胸膜凹陷、血管集束、空泡征和较大结节大小等影像学特征在肺癌患者中更为常见，并被确定为肺癌的独立危险因素。 结论：外周血清生物标志物，包括CYFRA21-1、CEA、ESM-1和NSE，对肺癌具有显著的诊断潜力。此外，影像学特征为鉴别肺癌提供了有价值的见解，强调了这两种诊断方法的临床适用性。
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