CEA、PCT水平在甲状腺髓样癌根治性手术治疗前后的检查意义

摘要/Abstract

摘要： 目的研究血清癌坯抗原（CEA）、降钙素原（PCT）水平在甲状腺髓样癌（MTC）根治性手术治疗前后的检查意义。方法回顾性分析2020年1月—2023年1月在西安市鄠邑区人民医院接受根治性手术治疗的80例MTC患者的临床病理数据及随访数据,分析血清CEA、PCT水平与术前病理特征关系,使用受试者工作特征曲线（ROC）分析CEA及PCT对MTC淋巴结转移的预测效能,根据术后随访情况将患者分为治愈组与复发/转移组,对比两组患者术后3个月、6个月血清CEA、PCT水平。结果术前,血清CEA、PCT水平在不同性别、年龄患者中比较,差异无统计学意义（P>0.05）,但在单病灶与多病灶、肿瘤<2 cm与≥2 cm、有淋巴结转移与无淋巴结转移患者之间比较,差异具有统计学意义（P<0.05）;术前血清CEA对MTC淋巴结转移的预测截断值为35.75 ng/mL,灵敏度为84.61%,特异度为72.53%;PCT对MTC淋巴结转移的预测截断值为3.65 ng/mL,灵敏度为86.52%,特异度为80.77%;随访发现复发/进展患者术后3个月、6个月血清CEA、PCT水平高于治愈患者,差异具有统计学意义（P<0.05）。结论术前血清CEA及PCT水平可以较好的反映出MTC患者肿瘤的大小、病灶数量情况,对淋巴结转移具备较好的预测能力,术后血清CEA及PCT水平可以较好反映出病情进展情况。

关键词: 癌坯抗原, 降钙素原, 甲状腺髓样癌, 淋巴结转移, 病情进展

Abstract: Objective To study the significance of serum carcinoembryonic antigen (CEA) and procalcitonin (PCT) levels before and after radical surgery for medullary thyroid carcinoma (MTC). Methods The clinicopathological data and follow-up data of 80 MTC patients who underwent radical surgery in our hospital from January 2020 to January 2023 were retrospectively analyzed, and the relationship between serum CEA and PCT levels and preoperative pathological characteristics was analyzed. The predictive efficacy of CEA and PCT for MTC lymph node metastasis was analyzed by receiver operating characteristic curve (ROC). According to the postoperative follow-up, patients were divided into cure group and recurrence/metastasis group, and the serum CEA and PCT levels of the two groups were compared in March and June after operation. Results There was no significant difference in serum CEA and PCT levels between patients of different sexes and ages before operation (P>0.05), but there were significant differences between patients with single lesion and multiple lesions, tumors < 2 cm and ≥2cm, and patients with and without lymph node metastasis (P<0.05). The cutoff value of preoperative serum CEA for predicting MTC lymph node metastasis was 35.75 ng/mL, with sensitivity of 84.61% and specificity of 72.53%. The cutoff value of PCT for predicting MTC lymph node metastasis is 3.65ng/mL, with sensitivity of 86.52% and specificity of 80.77%. Follow-up showed that the serum CEA and PCT levels in patients with recurrence/progression were higher than those in patients with cure at 3 months and 6 months after operation, and the difference was statistically significant (P<0.05). Conclusion Preoperative serum CEA and PCT levels can better reflect the tumor size and the number of lesions in MTC patients, and have a good predictive ability for lymph node metastasis, while postoperative serum CEA and PCT levels can better reflect the progress of the disease.

Key words: carcinoembryonic antigen, procalcitonin, medullary thyroid carcinoma, lymph node metastasis, disease progression

中图分类号:

R736.1

王娟. CEA、PCT水平在甲状腺髓样癌根治性手术治疗前后的检查意义[J]. 中华养生保健, 2024, 42(13): 38-41.

WANG Juan. The Significance of CEA and PCT Levels Before and after Radical Surgery for Medullary Carcinoma of Thyroid[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(13): 38-41.

参考文献

[1] 关海霞,邝建.血清降钙素在甲状腺髓样癌全程管理中意义与应用[J].中国实用外科杂志,2020,40(9):1039-1042.
[2] 李田田,薛文华,秦迁,等.糖类抗原125,癌胚抗原和神经特异性烯醇酶联合检测在食管鳞癌诊断中的应用价值[J].肿瘤基础与临床,2021,34(4):311-313.
[3] 殷德涛,杜公博.家族性甲状腺髓样癌诊断与治疗[J].中国实用外科杂志,2020,40(9):1055-1058.
[4] 张刚,陈懿,徐琰.CEA异常升高首诊的遗传性甲状腺髓样癌家系的临床诊治和基因突变分析[J].中国医药导报,2018,15(14):83-85,101,封3.
[5] KIM M, KIM B H.Current Guidelines for Management of Medullary Thyroid Carcinoma[J]. Endocrinol Metab (Seoul), 2021,36(3):514-524.
[6] KRATZSCH J, WILLENBERG A, FRANK-RAUE K, et al.Procalcitonin measured by three different assays is an excellent tumor marker for the follow-up of patients with medullary thyroid carcinoma[J].Clin Chem Lab Med,2021,59(11):1861-1868.
[7] 杨珍芳,刘慧,王金花.甲状腺髓样癌的临床病理特点及分析[J].疾病监测与控制,2022,16(4):253-255,259.
[8] 张浩,秦元.散发性甲状腺髓样癌术式选择及预后分析[J].中国实用外科杂志,2020,40(9):1043-1045.
[9] 刘茜辉,聂鑫,贺勇等.基础血清降钙素值对甲状腺髓样癌的鉴别诊断价值[J].四川大学学报(医学版),2023,54(2):432-438.
[10] 叶柳青,吴梅娟,郑逸吟,等.术前血小板淋巴细胞比值评估甲状腺髄样癌淋巴结转移及预后的价值[J].浙江医学,2023,45(3):251-255.
[11] 张勇跃,梅放,崔立刚,等.超声联合血清CEA在甲状腺髓样癌中的诊断价值[J].中国超声医学杂志,2022,38(4):374-377.
[12] 沈鑫,朱云,黄波涛,等.甲状腺髓样癌的术前诊断:细针穿刺细胞学联合血清降钙素、癌胚抗原及穿刺洗脱液降钙素的应用[J].诊断病理学杂志,2022,29(5):417-422.
[13] CALIFANO I, PITOIA F, CHIRICO R, et al.Prospective study on the clinical relevance of 18F-DOPA positron emission tomography/computed tomography in patients with medullary thyroid carcinoma[J].Endocrine,2022,77(1):143-150.
[14] 丁金旺,郑伟慧,赵佳正,等.术前血清降钙素检测在评估甲状腺髓样癌不同区域淋巴结转移中的临床价值[J].中国耳鼻咽喉头颈外科,2021,28(1):1-4.
[15] 胡欣,韩雪,陈国芳,等.血清降钙素原在甲状腺髓样癌诊断及随访中的临床价值[J].临床内科杂志,2020,37(1):69-70.
[16] 张大奇,张晗,隋成秋,等.甲状腺髓样癌病人围手术期降钙素及癌胚抗原水平变化研究[J].中国实用外科杂志,2020,40(9):1062-1068.
[17] 王慧,刘勤江,王云生.甲状腺髓样癌中降钙素和降钙素原的表达及临床意义[J].兰州大学学报(医学版),2020,46(4):25-29.
[18] 叶柳青. 血清癌胚抗原预测甲状腺髓样癌淋巴结转移的临床应用价值[C].中国抗癌协会肿瘤标志专业委员会.2017年中国肿瘤标志物学术大会暨第十一届肿瘤标志物青年科学家论坛论文汇编,2017:253-254.
[19] 叶柳青,丁金旺,周国明,等.血清癌胚抗原预测可手术甲状腺髓样癌淋巴结转移的临床价值[J].中华内分泌外科杂志,2020,14(1):37-41.
[20] 张灵羽,付利军,孙宁,等.血清proGRP、Ctn、CEA在甲状腺髓样癌鉴别诊断和预测颈侧区淋巴结转移中的价值[J].郑州大学学报(医学版),2022,57(2):271-275.