曹达魁 王海琴

[摘要] 目的 探討循环肿瘤细胞、癌胚抗原及影像学对非小细胞肺癌（NSCLC）诊断价值分析。 方法 选择2018年9月至2019年8月我院病理确诊的43例NSCLC患者、同期入院的43例良性肺部疾病患者及43例健康者为研究对象，检测并分析三组CTC、CEA及胸部CT在诊断NSCLC中的价值。 结果 肺癌组CTC阳性率为79.07%，良性肺部疾病组CTC阳性率为4.65%。健康组CTC阳性率0%。肺癌组与良性肺部疾病组、健康组比较，差异有统计学意义（P<0.05）。肺癌患者吸烟患者CTC阳性率为95.00%，二手烟吸入者阳性率为77.78%，无吸烟史CTC阳性率则为20.00%，三组之间差异有统计学意义（P<0.05）。Ⅰ～Ⅱ期患者CTC无检出，Ⅲ期CTC阳性率为68.75%，Ⅳ期CTC阳性率为92.00%，各亚组比较差异有统计学意义（P<0.05）。有远处转移者CTC阳性率为95.83%，无远处转移者CTC阳性率为57.89%。CEA≤5 ng/mL患者中CTC阳性率为46.67%，CEA>5 ng/mL患者中CTC阳性率为96.43%。而CTC阳性率与性别、年龄、PS评分、病理学类型及CT位置表现差异无统计学意义（P>0.05）。CEA临界值为6.55 ng/mL时，敏感性为62.8%，特异性83.7%;CTC临界值为1.03时，敏感性79.1%，特异性98.8%。CTC的敏感性及特异性均要高于CEA，但三者联合则具有更高的诊断效率。 结论 在NSCLC诊断中CTC敏感性及特异性比CEA及胸部CT高，CTC与NSCLC患者吸烟情况、临床分期、远处转移有关，CTC与CEA及胸部CT结合可显著提高NSCLC的诊断率。

[关键词] 循环肿瘤细胞;癌胚抗原;胸部CT;非小细胞肺癌

[中图分类号] R734.2          [文献标识码] B          [文章编号] 1673-9701（2021）08-0046-04

The diagnostic value of circulating tumor cells， CEA and imaging for non-small cell carcinoma

CAO Dakui   WANG Haiqin

Department of Respiratory Medicine， Jiaxing Second Hospital in Zhejiang Province， Jiaxing   314000， China

[Abstract] Objective To discuss and analyze the diagnostic value of circulating tumor cells， CEA and imaging for non-small cell carcinoma. Methods A total of 43 patients with NSCLC confirmed by pathology in our hospital from September 2018 to August 2019， 43 patients with benign pulmonary disease admitted in the same period， and 43 healthy patients were selected as the study subjects. The values of CTC， CEA and chest CT in the diagnosis of NSCLC in three groups were detected and analyzed. Results The CTC positive rate was 79.07% in the lung cancer group， 4.65% in the benign lung disease group， and 0% in the healthy group. Significant differences were observed among the lung cancer group， the benign lung disease group， and the healthy group（P<0.05）. The positive rate of CTC was 95.00% in lung cancer patients who smoked， 77.78% in those who inhaled second-hand smoke， and 20.00% in those who had no smoking history， with significant differences among the three groups（P<0.05）. No CTC was detected in stage Ⅰ-Ⅱ patients; the positive rate of CTC in stage Ⅲ was 68.75%; the positive rate of CTC in stage Ⅳ was 92.00%; statistically significant differences were observed among the subgroups（P<0.05）. The CTC positive rate was 95.83% in those with distant metastasis and 57.89% in those without distant metastasis. The CTC positive rate was 46.67% in patients with CEA≤5 ng/mL and 96.43% in patients with CEA>5 ng/mL. No statistical significances were observed in the CTC positive rate with gender， age， PS score， pathological type and CT location（P>0.05）. When CEA threshold was 6.55 ng/mL， the sensitivity and the specificity were 62.8% and 83.7%. When the CTC threshold was 1.03， the sensitivity and specificity were 79.1% and 98.8%. The sensitivity and specificity of CTC were higher than those of CEA， but the combination of the three had a higher diagnostic efficiency. Conclusion In the diagnosis of NSCLC， the sensitivity and specificity of CTC are higher than those of CEA and chest CT. CTC is related to the smoking status， clinical stage and distant metastasis of NSCLC patients. The combination of CTC， CEA and chest CT can significantly improve the diagnostic rate of NSCLC.

[Key words] Circulating tumor cells; CEA; Chest CT; Non-small cell lung cancer

目前我国发病率及病死率最高的恶性肿瘤是肺癌[1]，非小细胞肺癌占其中的 80%～85%，大多数肺癌患者的预后较差，总体5年生存率约为18.1%，大多数患者就诊时已处于晚期[2]。作为肺癌早期筛查手段，以癌胚抗原为代表的血清肿瘤标志物检测和胸部CT检查已被广泛应用。肺癌主要死因多为远处转移，血行播散是转移的重要途径。循环肿瘤细胞（Circulating tumor cells，CTC）是指原发肿瘤或转移病灶内的肿瘤细胞通过主动迁移、侵袭或者外在因素干扰导致其被动脱落，从而进入循环血液所形成。CT……