The Clinical Significance Of ProGRP And NSE In Diagnosis And Curative Effect Evaluation Of Small Cell Lung Cancer

Objective:Evaluate the clinical significance of pro-gastrin releasing peptide(ProGRP)and neuron specific enolase(NSE)in diagnosis and curative effect of small cell lung cancer(SCLC).Method:1.Measuring the serum levels of ProGRP and NSE by electrochemiluminescence immunoassay in 47 patients with newly diagnosed SCLC(26 patients with limited disease LD,21 patients with extensive disease ED).53 patients with NSCLC,59 patients with benign pulmonary disease and 71 cases of healthy medical examination people.The data was skewed distribution,so it was expressed as interquartile range [M(P25-P75)].The multiple groups were compared with Kruskal-wallis H test,P<0.05 were considered statistically significant.Mann-Whitney U test was used by analyzing between two groups.The size of test(a=0.05)was divided by 6 because of 4 times of groups comparison,so P<0.008 were considered statistically significant.Using the receiver operating characteristic curve(ROC)to set cut-off value and measure the areas under receiver operating characteristic curve(ROC-AUC)of ProGRP and NSE.Z test was used to compared ROC-AUC.Sensitivity and specificity were analyzing by Chi-square test.2.Chemotherapy for small cell lung cancer is etoposide(VP 16)plus cis-platinum.Observation of SCLC before chemotherapy and after 2 cycles and 4 cycles of chemotherapy changed levels of ProGRP and NSE combing remission after chemotherapy,evaluate the value of ProGRP and NSE in chemotherapy efficacy of small cell lung cancer.Result:1.Kruskal-wallis H test showed significantly statistical difference in serum levels of ProGRP and NSE in different groups(H values were 70.121 and 38.309,P<0.001).The serum levels of ProGRP and NSE in LD-SCLC group,ED-SCLC group,NSCLC group,benign pulmonary disease group and healthy control group were statistically different compared by the non-parametric Kruskal-wallis H(H values were 74.472 and 49.31,P<0.001).Mann-Whitney U test showed statistical difference in serum levels of ProGRP and NSE between SCLC and healthy control groups,SCLC and benign pulmonary disease groups,SCLC and NSCLC groups(U values of ProGRP were 329.0,341.0 and 348.5,P<0.001,U values of NSE were 682.0,565.0 and 648.0,P<0.001).Serum levels of ProGRP in LD-SCLC was significantly increased than those in the healthy control group(U=567.0,P<0.008),benign pulmonary diseases group(U=306.0,P<0.001)and NSCLC group(U=301.5,P<0.001).Serum level of NSE in LD-SCLC was increased than those in the healthy control group(U=567.0,P<0.008)and benign pulmonary diseases group(U=436.5,P<0.008),the difference between LD-SCLC group and NSCLC group were have no statistical significance for NSE(U=524.0,p>0.008).In ED-SCLC group ProGRP and NSE were higher than LD-SCLC group(U=113.0 and 129.0,P<0.008).2.Analysing the ROC(receiver operating curve)result showed that :using healthy control group,benign pulmonary diseases group and NSCLC group as controls,ROC-AUC(the areas under receiver operating characteristic curves)of ProGRP was statistically higher than that of NSE in the SCLC group(Z= 2.01?1.99 and 2.05,P<0.05).the ROC-AUC of combining detection of ProGRP and NSE was not different with ProGRP itself.(Z= 0.02?0.04 and 0.11,P>0.05).The sensitivity of ProGRP was significantly higher than NSE in the SCLC group using healthy control group,benign pulmonary diseases group and NSCLC group as controls respectively.(X2=4.9?4.9?4.0,P<0.05).AT the same time,use the NSCLC group,healthy control group and benign pulmonary diseases group as controls respectively,the sensitivity of ProGRP was significantly higher than NSE in the LD-SCLC group(X2=4.0?5.81?5.81,P<0.05).3.During the course of therapy the levels of ProGRP and NSE were valuable in selection of chemotherapy and evaluate the curative effect.10 LD-SCLC patients(A group)were chemotherapy sensitivity(CR+PR+SD),the serum levels of ProGRP and NSE were decreased after 2 cycles of chemotherapy(Z levels were-2.803,-2.803,P<0.05).3 LD-SCLC patients(B group)have poor effect(PD),the serum levels of ProGRP and NSE were have no statistically significant changes(Z levels were-1.069,-1.604,P>0.05).The patient ED-SCLC with high value of ProGRP(C group)was partial remission(PR),ProGRP and NSE dramatic decline.2 patients with high value of ProGRP and NSE in ED-SCLC(D group),tumors increased and the serum levels of ProGRP and NSE associated with disease progression(Z levels were-1.342,-0.447,P>0.05).Conclusion:ProGRP and NSE have high value in diagnosis and curative effect evaluation of small cell lung cancer.ProGRP is better than NSE in diagnosis in early stage of lung cancer.