Clinical Significance Of Combined Detection Of TK1,CEA And D-Dimer In Advanced Non-Small Cell Lung Cancer

Background: Lung cancer(LC),also known as bronchial lung cancer,is a malignant tumor that originates in the bronchial mucosa or glands.In recent years,the incidence of LC has been increasing year by year because of the worsening of environmental and dietary pollution,and it has become one of the diseases that seriously affect the health of the residents in our country.China’s cancer statistics in 2015 show that lung cancer is the highest mortality rate for both men and women.And NSCLC(non-small cell lung cancer)accounts for about 80% to 85% in lung cancer.At present,cytology,histopathology is the gold standard diagnosis of lung cancer.Imaging is an auxiliary diagnosis and can use to evaluate the efficiency of the treatment.However,the cytology and histopathological examination have a certain degree of trauma,and longer diagnosis cycle,poor repeatability,and often accompanied with various complications.Imaging examination have relatively high cost and a certain radiation,the early or potential blood transfer is often miss diagnose,and the evaluation of curative effect aslo have some limitations.Therefore,there is an urgent need for a relatively simple operation,low cost,small trauma to solve the above problems.Studies at home and abroad have confirmed that the detection of tumor marker(TM)is of great significance in helping patients to find tumor early and guiding clinical treatment.However,the low specificity and sensitivity of single serum tumor markers lead to limited clinical diagnostic value.In order to make up for the deficiency mentioned above,it is proposed that combined detection of thymidine kinase 1,D-dimer and CEA can be used in the diagnosis and curative effect prediction of advanced non-small cell lung cancer and provide a new idea for the diagnosis and curative.effect prediction.Objective: To investigate the effect of combined detection of TK1,CEA,and D-D in patients with advanced NSCLC,and provide a reference for the diagnosis and curative effect prediction of advanced NSCLC.Methods:From December 2016 to December 2017,sixty seven patients with advanced NSCLC(fifty four adenocarcinoma and thirteen squamous cell carcinoma)in our hospital were selected as observation group,and twenty patients who were health examination in the same period were selected as control group.In the two groups,the concentration of thymidine kinase1 was determined by enzyme linked immunosorbent assay(Elisa),The concentration of D-dimer was determined by immunoturbidimetry,and the concentration of CEA was determined by chemiluminescence assay.According to the results of EGFR gene detection and the financial situation of patients,67 patients in observation group were treated with chemotherapy therapy for at least2 cycles or one course of targeted therapy,before the third cycle of chemotherapy or before the second course of targeted therapy the concentrations of TK1,D-D and CEA were measured and the imaging examinations were performed at the same time,observation group divided into PD(Progressive Disease)group and DC(Disease Control)group according to the RECIST 1.1.To analysis the diagnostic effect and curative effect prediction of combined detection of TK1,CEA,D-Dimer in advanced non-small cell lung cancer.Results:1.There was no significant difference in the sex ratio,smoking status and age distribution in eighty seven samples(p > 0.05).2.The concentrations of TK1,CEA and D-D in patients with lung adenocarcinoma were significantly higher than those in the control group.The difference is statistically significant(p > 0.05).The ROC curve analysis showed that TK1,D-D,CEA detected alone or combined with every two or three were have diagnostic value in lung adenocarcinoma(p < 0.05).CEA has the largest area under curve and youden index in single detection.The area under curve and youden index of combination of two or three indexs were larger than that of single detection,and the area under curve and youden index of D-D combined with TK1 was the largest,the diagnostic sensitivity and specificity are high.3.The TK1 and CEA concentrations were not statistically significant in lung Squamous cell carcinoma and control groups(p > 0.05),and the D-D concentration of lung squamous cell carcinoma and the control group was statistically significant(p <0.05),suggesting that it is helpful to the diagnosis of lung squamous cell carcinoma.But this study its Youden index and the area under the curve were significantly lower than those in lung adenocarcinoma group.4.After two cycles of chemotherapy or one course of targeted therapy,in lung Adenocarcinoma patients the concentration of TK1 and CEA,D-D in imaging evaluated PD group were higher than those before treatment,the concentration of TK1 and CEA,D-D in imaging evaluated DC group were lower than those before treatment.The difference was statistically significant(p < 0.05);but in lung squamous Cell carcinoma patients both PD or DC group,there was no significant difference of concentration of TK1,CEA,D-D before and after treatment.(p > 0.05).5.In lung adenocarcinoma patients tumor markers in DC patients decreased and tumor markers increased in PD patients,there was statistical difference in the change rate of PD and DC between TK1,CEA,D-D(p < 0.05).According to the ROC curve,detected alone or combined with every two or three were haves values in evaluating the curative effect of lung adenocarcinoma(p < 0.05).D-D have the largest under curve and youden index in single detection.The area under curve and youden index of combination of two or three indexs were larger than that of single detection.D dimer combined with TK1 have the larger area under the curve,and the youden index was the highest,the sensitivity and specificity were also higher.6.There was no difference in the change rate of TK1,CEA,and D-D between PD and DC in patients with lung squamous cell carcinoma(p > 0.05).The ROC curve analysis showed that none of the three indexes could predict the curative effect of lung squamous cell carcinoma(p > 0.05).Conclusion:1.The detection of TK1,CEA,D-dimer have a certain value in the diagnosis and evaluation of curative effect of advanced lung adenocarcinoma.In single detection CEA have the highest diagnostic value,D-D have the highest predictive value of efficacy.TK1,CEA have no diagnostic value in advanced lung squamous cell carcinoma(p>0.05),D-dimer have a certain value in the diagnosis of advanced lung squamous cell carcinoma,but its diagnostic value may be lower than that of lung adenocarcinoma.The detection of TK1,CEA,D-dimer haven’t see value in the prediction of the therapeutic effect in advanced lung squamous cell carcinoma(SCC).2.The detection combined with TK1,CEA and D-dimer can improve the value diagnosis and prediction of curative effect in advanced lung adenocarcinoma.TK1 combined with D-dimer is of great significance,which can be helpful to clinical diagnosis and prediction of curative effect.3.Due to the small sample size included in this study,especially the lung squamous cell carcinoma sample size is too small,we will continue to increase the sample size to demonstrate our results in the future.