Significance Of Combining CTAPⅢ/CXCL7 And Tumor Markers In The Diagnosis Of Squamous Cell Carcinoma And Adenocarcinoma

Objective: To investigate the clinical significance of combining connective tissue activating peptide III/ chemokine 7(CTAPIII/CXCL7)and tumor markers including carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CY211),squamous cell carcinoma antigen(SCC)for the diagnosis of squamous cell carcinoma and adenocarcinoma.Material and methods: A total of 419 patients were collected from the Second Hospital of Dalian Medical University from August 2015 to May 2016,including 265 lung cancer patients and 154 healthy people.According to the randomized grouping method,all the people were randomly divided into two groups: training group of 209people(103 adenocarcinoma,29 squamous cell carcinoma and 77 healthy people)and testing group of 210 people(104 adenocarcinoma,29 squamous cell carcinoma and 77 healthy people).The plasma levels of CEA,SCC and CY211 were detected by chemiluminescence microparticle immuno assay and plasma CTAPIII/CXCL7 was detected by Elisa.The concentration between the two groups were analyzed by the nonparametric Wilcoxon test(Mann-Whitney U test);the receiver operating characteristic curve(ROC)was used to assess the accuracy of different tumor markers in diagnosis,and further analysisd of the relevant indicators including the sensitivity,specificity and the area under the curve(area under,curve,AUC).The best threshold value for biomarker was decided when specificity was 95%.Binary logistic regression was used to analyze the diagnostic effect of CTAPIII/CXCL7 combined with CEA,SCC and CY211 in squamous cell carcinoma and adenocarcinoma.Results: 1.The level of plasma CTAPIII/CXCL7 in patients with adenocarcinoma were slightly higher than the plasma CTAPIII/CXCL7 level in patients with squamous cell carcinoma among the training group,the testing group and the general object,but there was no significant difference between the two(P > 0.05).2.Among adenocarcinoma,the median level of CTAPIII/CXCL7 in the stage I-IV were 1473.87±937.78ng/m L,1569.60±905.83ng/m L,1553.25±640.54ng/m L,1688.28±972.41ng/m L.The concentration level of IV is highest,but there was no significant difference between each stage(P > 0.05).Among squamous cell carcinoma,the median level of CTAPIII/CXCL7 in the stage I-IV were 1293.11±435.11ng/m L,1675.39±1068.50ng/m L,1397.52±544.39ng/m L,1339.02±428.23ng/m L.The concentration level of stage II was the highest,but there was no significant difference between groups(P > 0.05).In squamous cell carcinoma and adenocarcinoma,there was no significant difference in plasma CTAPIII/CXCL7 level between different stages(P >0.05).3.In order to improve the accuracy of diagnosis,the threshold value was selected,when the specifity of training group is 95%.The threshold value of CEA is5.95ng/m L,the threshold value of SCC is 2.55ng/m L,the threshold value of CY211 is2.36ng/m L,the threshold value of CTAPIII/CXCL7 is 1309.45ng/m L.In adenocarcinoma,CTAPIII/CXCL7 has the highest AUC and sensitivity.In the training group: AUC is 0.800,and sensitivity is 41.7%,the validation group: AUC is 0.775,and sensitivity is 49%.In squamous cell carcinoma,CY211 has the highest AUC and sensitivity.In the training group: AUC is 0.906,and sensitivity is 75.9%,the validation group: AUC is 0.806,sensitivity is 72.4%.In the diagnosis of lung cancer,CTAPIII/CXCL7 has the highest AUC and sensitivity,and the training group: AUC is0.806,sensitivity is 43.2%,the validation group: AUC is 0.773,sensitivity is 45.9%.4.In order to improve the diagnostic value,binary logistic regression was used to analyze the diagnostic effect of CTAPIII/CXCL7 combined with CEA,SCC and CY211.In the training group,AUC is 0.909,95%CI 0.871-0.946,when the specificity is95%,the sensitivity is 72.7%,the risk coefficient is 0.739;in the testing group: AUC is0.892,95%CI 0.850-0.934,the sensitivity ias 62.4%,specificity is 96.1%.5.In the diagnosis of stage I lung cancer,CTAPIII/CXCL7 has the highest AUC and sensitivity: the training group AUC is 0.778,the sensitivity is 35.2%;the testing group,AUC is 0.729,sensitivity is 39.3%.Combined with various biomarkers can improve the diagnostic efficiency.In training group,AUC is 0.794,the sensitivity is44.4%.In the testing group,AUC is 0.804,and the sensitivity is 42.9%.In the diagnosis of stage Ia lung cancer,CTAPIII/CXCL7 also has the highest AUC and sensitivity.In the training group,AUC is 0.787,and sensitivity is 33.3%.In the testing group,AUC is 0.742,sensitivity is 35.9%.Combined with various biomarkers can improve the diagnosis efficiency.In the training group,AUC is 0.790,the sensitivity is 37.5%,In the testing group,AUC is 0.791,and the sensitivity is 38.5%.Conclusion: CTAPIII/CXCL7 can be used as biomarker to identify adenocarcinoma and squamous cell carcinoma and healthy people which show a better diagnostic performance than traditional tumor markers(CEA,SCC,CY211),especially in the early stage of lung cancer.