肺癌患者外周血癌胚抗原、细胞角蛋白19 mRNA表达水平与肿瘤分期、近期疗效及预后的关系

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目的探讨肺癌患者治疗前后外周血癌胚抗原(CEA)、细胞角蛋白19(CK19)mRNA的表达水平及其与肿瘤分期、近期疗效、预后的关系。方法应用Taq M an定量逆转录-聚合酶链反应(RT-PCR)检测78例肺癌患者(鳞癌28例、腺癌40例、小细胞肺癌9例、大细胞肺癌1例)治疗前后、30例肺部良性疾病患者及30名健康对照者外周血癌胚抗原(CEA)、细胞角蛋白19(CK19)mRNA的水平;同时采用酶联免疫吸附法测定肺癌患者治疗前血清CEA和细胞角蛋白19片段(CYFRA21-1)水平。患者随访2年。结果肺癌患者外周血CEA、CK19 mRNA阳性率分别为69.2%(54/78)、62.8%(49/78),显著高于肺部良性疾病患者及健康对照者,三者差异有统计学意义(χ2值分别为37.65、41.54;27.41、30.84,P均<0.01)。鳞癌组CK19 mRNA阳性率最高,腺癌组CEA mRNA阳性率最高。不同分期肿瘤患者间CEA、CK19 mRNA阳性率差异无统计学意义(χ2值分别为3.63、3.81,P>0.05)。肺癌患者外周血CEA、CK19 mRNA的阳性率显著高于CEA、CYFRA21-1蛋白水平;手术后CEA、CK19 mRNA阳性率显著下降;化疗后阳性率下降不明显。化疗前CEA mRNA阳性患者的中位生存期明显低于阴性患者(分别为8.5、11.7个月),化疗前CK19 mRNA阳性患者的中位生存期明显低于阴性患者(分别为8.9、12.3个月);术前CEA mRNA阳性患者肿瘤复发或转移率(29.4%)高于术前阴性患者(7.7%),术前CK19 mRNA阳性患者肿瘤复发或转移率(18.8%)高于术前阴性患者(7.1%)。结论检测肿瘤患者外周血CEA、CK19 mRNA水平对于预测肿瘤细胞微转移有一定的临床意义,有助于评估手术疗效及预测预后。CEA、CK19 mRNA表达水平与肿瘤分期无关。CEA、CK19基因检测的敏感性优于蛋白水平的检测,有助于肺癌的辅助诊断。 Objective To investigate the expression of carcinoembryonic antigen (CEA), cytokeratin 19 (CK19) mRNA in patients with lung cancer before and after treatment and its relationship with tumor staging, short-term efficacy and prognosis. Methods 78 patients with lung cancer (28 squamous cell carcinoma, 40 adenocarcinoma, 9 small cell lung cancer and 1 large cell lung cancer) were detected by Taq M an quantitative reverse transcription polymerase chain reaction (RT-PCR) before and after treatment The serum levels of CEA and CK19 mRNA in patients with benign pulmonary diseases and 30 healthy controls were determined. Serum CEA and cytokeratin 19 levels were measured by enzyme-linked immunosorbent assay Fragment (CYFRA21-1) levels. Patients were followed up for 2 years. Results The positive rates of CEA and CK19 mRNA in peripheral blood of patients with lung cancer were 69.2% (54/78) and 62.8% (49/78) respectively, which were significantly higher than those of patients with benign lung diseases and healthy controls (P < χ2 values ​​were 37.65,41.54; 27.41,30.84, P <0.01). The positive rate of CK19 mRNA in squamous cell carcinoma was the highest, and the positive rate of CEA mRNA in adenocarcinoma was the highest. There was no significant difference in the positive rates of CEA and CK19 between patients with different stages of cancer (χ2 = 3.63,3.81, P> 0.05). The positive rates of CEA and CK19 mRNA in peripheral blood of patients with lung cancer were significantly higher than those of CEA and CYFRA21-1. The positive rates of CEA and CK19 mRNA were significantly decreased after operation, but the positive rates of chemotherapy were not decreased significantly after operation. The median survival of patients with positive CEA mRNA before chemotherapy was significantly lower than that of negative patients (8.5 and 11.7 months, respectively). The median survival of CK19 mRNA positive patients before chemotherapy was significantly lower than that of negative patients (8.9 and 12.3 months ). The tumor recurrence or metastasis rate in preoperative CEA mRNA positive patients (29.4%) was higher than that in preoperative negative patients (7.7%). The preoperative CK19 mRNA positive patients had higher tumor recurrence or metastasis rate (18.8%) than preoperative negative patients 7.1%). Conclusion Detection of CEA and CK19 mRNA in peripheral blood of patients with cancer has certain clinical significance in predicting the micrometastasis of tumor cells, which is helpful to evaluate the curative effect and prognosis. CEA, CK19 mRNA expression levels and tumor stage has nothing to do. The sensitivity of CEA and CK19 detection is better than that of protein, which is helpful for the diagnosis of lung cancer.
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