张颖 王淑玲 陈云峰 李涛

【摘要】 目的：探究多種血清肿瘤标志物联合判断老年晚期肺腺癌EGFR突变的价值。方法：选取2017年1月-2019年1月本院收治的且均经基因检测的162例肺腺癌患者作为研究对象，根据基因检测结果分为研究组（EGFR基因突变患者，n=102）和对照组（非EGFR基因突变患者，n=60），对比分析两组糖类抗原（CA125）、癌抗原153（CA153）、细胞角蛋白19片段（CYFRA21-1）和癌胚抗原（CEA）水平和阳性率，分析其对EGFR基因突变的预测能力。结果：研究组CEA、CA125、CYFRA21-1和CA153均明显高于对照组（P<0.05），且研究组CEA、CA125、CYFRA21-1和CA153阳性率均明显高于对照组（P<0.05）。四项指标联合检测敏感度为93.14%，特异度为85.00%，均显著高于CEA、CA125、CYFRA21-1和CA153单项检测（P<0.05）。结论：CA125、CA153、CYFRA21-1和CEA等肿瘤标志物能预测EGFR基因突变，且四项指标联合检测可增加其阳性预测准确率，为EGFR-TKIs靶向治疗提供重要参考。

【关键词】 血清肿瘤标志物 老年肺腺癌 晚期 表皮生长因子受体 癌胚抗原

Value of Multiple Serum Tumor Markers in the Diagnosis of EGFR Mutation in Elderly Advanced Lung Adenocarcinoma/ZHANG Ying， WANG Shuling， CHEN Yunfeng， LI Tao. //Medical Innovation of China， 2021， 18（28）： -129

[Abstract] Objective： To explore the value of multiple serum tumor markers in the diagnosis of EGFR mutation in elderly advanced lung adenocarcinoma. Method： A total of 162 patients with lung adenocarcinoma admitted to our hospital from January 2017 to January 2019 were selected as the research subjects. According to the gene test results， they were divided into the study group （patients with EGFR gene mutation， n=102） and the control group （patients with non EGFR gene mutation， n=60）. The levels and positive rates of carbohydrate antigen （CA125）， cancer antigen 153 （CA153）， cytokeratin 19 fragment （CYFRA21-1） and carcinoembryonic antigen （CEA） were compared and analyzed between two groups， its ability to predict EGFR gene mutations were analyzed， the prediction ability of EGFR gene mutation was analyzed. Result： The levels of CEA， CA125， CYFRA21-1 and CA153 in the study group were significantly higher than those in the control group （P<0.05）， the positive rates of CEA， CA125， CYFRA21-1 and CA153 in the study group were significantly higher than those in the control group （P<0.05）. The sensitivity and specificity of the combined detection of four indexes were 93.14% and 85.00%， which were significantly higher than those of CEA， CA125， CYFRA21-1 and CA153 （P<0.05）. Conclusion： CA125， CA153， CYFRA21-1 and CEA levels can predict EGFR gene mutation， the combined detection of four indexes can increase the positive prediction accuracy， it can provide important reference for EGFR-TKIs targeted therapy.

[Key words] Serum tumor markers Elderly lung adenocarcinoma Advanced Epidermal growth factor receptor Carcinoembryonic antigen

First-author’s address： The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University， Xuzhou 221100， China

doi：10.3969/j.issn.1674-4985.2021.28.031

近些年来，肺癌的致死率逐年攀升，其中非小细胞肺癌（non-small cell lung cancer，NSCLC）占肺癌总数的80%左右[1]，肺腺癌是NSCLC的一种，由于其多发生于老年人，且具有早期易转移、恶性速度快、发病率和致死率均较高等特点，患者发现时大多数已经是晚期，大部分患者确诊为肺癌时早已失去手术治疗的机会。目前治疗晚期肺腺癌患者常用的治疗方式是以表皮生长因子受体-酪氨酸激酶抑制剂（EGFR-TKIs）为代表的肿瘤靶向药物。对于表皮生长因子受体（epidermal growth factor receptor，EGFR）基因突变的患者，采用靶向药物治疗相较于标准化疗，能有效提高肿瘤缓解率，降低死亡风险，且明显改善其生存质量[2]。但是由于EGFR基因检测费用昂贵，且多数肺腺癌晚期患者身体状况较差、微创标本取材较少等多种因素影响，导致基因突变检测率较低。……