| Objective:The purpose of this study was to screen the most efficient combination of serum tumor markers for lung cancer diagnosis,and to explore the clinical value of single and combination tumor markers in lung cancer early diagnosis,pathological type,clinical stage,and therapeutic effect.Methods:789 lung cancer patients who were firstly treated in The First People's Hospital of Chenzhou between May 2014 and December 2017 without any anti-tumor treatment were selected as the observation group and the diagnosis of lung cancer was confirmed by pathological examination.In addition,377 healthy individuals and 870 benign lung disease patients in the hospital,during the same period were used as the control groups.The data of age,gender,smoking history,family history,tumor marker level,imaging results,pathological examination results,clinical stage of each person were collected.The expression levels of various tumor markers between lung cancer group and benign lung disease group,lung cancer group and healthy group were compared,and the difference between the two groups was analyzed by Mann-Whitney U test.The serum tumor markers closely correlated to the diagnosis of lung cancer were screened out by multivariate logistic regression analysis.In lung cancer group,logistic regression analysis was used to evaluate the correlation between each clinicopathological parameter(like as pathological type,clinical stage,and therapeutic effect,etc)and the expression level of serum tumor markers;Kruskal-Wallis H test was used to analyze the differences among multiple subgroups;Wilcoxon rank-sum test was used to test the differences in paired samples before and after treatment.The diagnostic efficacy of tumor markers was evaluated using the ROC curve,and the ROC curve of the logistic regression model was used to analyze the diagnosis efficacy of combining tumor markers of lung cancer.The difference of area under the curve(AUC)between groups was compared by manual Z test.Results:1.The expression levels of several serum tumor markers,CEA,CA242,CA153,CA125,FER and NSE,in lung cancer patients,were significantly higher than those in benign lung disease group and in healthy group.These markers were closely correlated to the diagnosis of lung cancer(p<0.05).Compared to other five markers,CEA had the highest AUC(0.757)in the diagnosis of lung cancer.The AUC of the combination detection of six serum tumor markers is 0.840.2.The expression level of NSE in small-cell lung cancer was significantly higher than that in other pathological types of lung cancer(p<0.05),and among the six markers,the AUC(0.875)of NSE was the highest for the diagnosis of small cell lung cancer.With non-small cell lung cancer as the control group,the AUC of NSE for the diagnosis of small cell lung cancer was 0.762,and the optimal cutoff value was 6.72 ng/ml.The expression levels of CEA,CA153 and CA242 in lung adenocarcinoma were significantly higher than those in other pathological types of lung cancer(p<0.05).For each serum tumor biomaeker,the AUC of CEA is the highest in the diagnosis of lung adenocarcinoma(0.823).The expression level of CA125 in lung adenocarcinoma was significantly higher than that in lung squamous cell carcinoma(p<0.05).The expression level of FER in lung squamous cell carcinoma was significantly higher than that in lung adenocarcinoma(p<0.05).The AUC of six serum tumor markers in combination diagnosis of small cell lung cancer,lung adenocarcinoma and lung squamous cell carcinoma were 0.924,0.882 and 0.757,respectively.3.In small cell lung cancer,the expression levels of CA125 and NSE in patients with extensive stage were significantly higher than those with limited stage,and the difference was statistically significant(p<0.05).The expression levels of CEA,CA242,CA153,and FER in patients with extensive stage were also higher than those with limited stage,but the differences were not statistically significant(p>0.05).In non-small cell lung cancer,the median levels of CEA,CA125,and NSE expression increased with the increase of TNM stages.The expression levels of CEA,CA125,NSE,CA242 and CA153 in patients with stage ?-?were significantly higher than those in patients with stage ?-?,and the difference was statistically significant(p<0.05).There was no significant difference in the expression level of FER in different stages(p>0.05).4.For each serum tumor biomarker,the AUC of NSE in diagnosis of small cell lung cancer is the highest in not only limited but also extensive stage(0.801 and 0.910).The AUC of six tumor markers(CEA,CA242,CA153,CA125,FER,and NSE)respectively were 0.875 and 0.946 in combination diagnosis of small cell lung cancer in limited stage and extensive stage.For each serum tumor biomarker,the AUC for CEA in diagnosis of non-small cell lung cancer is the highest in both ?-?and III-IV stages(0.620 and 0.770).The AUC of six tumor markers respectively were 0.712 and 0.838 in combination diagnosis of non-small cell lung cancer in ?-stage? and III-IV stage.5.In patients with partial response(PR),the expression levels of CEA,CA242,CA153,CA125 and NSE were decreased after chemotherapy compared with before chemotherapy(p<0.05),while there was no statistical difference in the expression levels of FER before and after chemotherapy(p>0.05).In patients with stable disease(SD),there was no statistical difference in the expression levels of six serum tumor markers before and after chemotherapy(p>0.05).In patients with progressive disease(PD),the expression levels of CEA,CA125 and NSE were increased after chemotherapy(p<0.05),and there was no statistical difference in the expression level of the other three markers before and after chemotherapy(p>0.05).Conclusion:1.The combined detection using CEA,CA242,CA153,CA125,FER and NSE can improve the diagnostic efficiency of lung cancer.This combination has reference value for the early diagnosis of lung cancer.2.NSE is a good marker for the diagnosis of small cell lung cancer and it can be used to differential diagnosis between small cell lung cancer and non-small cell lung cancer.The optimal cutoff value of NSE was 6.72 ng/ml.3.NSE has reference value for clinical staging of small cell lung cancer.However,CEA and CA125 has reference value for clinical staging of non-small cell lung cancer.4.CEA,CA125 and NSE have certain reference value in evaluating the curative effect for lung cancer chemotherapy. |
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