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目的:探讨血清肿瘤标志物细胞角蛋白19片段(cytokeratin 19 fragment,Cyfra 21-1)、鳞状细胞癌抗原(squamous cell carcinoma antigen,SCCAg)、铁蛋白(Ferritin)、癌胚抗原(carcino-embryonic antigen,CEA)、糖类抗原19-9(Carbohydrate antigen,CA19-9)和甲胎蛋白(α-fetoprotein,AFP)对口腔/口咽鳞癌的诊断价值。方法:169例口腔/口咽鳞癌患者为实验组,86例口腔良性肿瘤患者为良性肿瘤对照组,30例健康人为健康人对照组,用电化学发光免疫测定法(electro chemiluminescence immunoassay,ECLIA)检测各组血清Cyfra 21-1、SCCAg、Ferritin、CEA、CA19-9、AFP的水平,数据经SPSS 21.0统计软件处理,并行ROC(receiver operator characteristic)曲线分析。结果:实验组血清Cyfra 21-1、SCCAg、Ferritin和CEA水平分别明显高于良性肿瘤对照组和健康人对照组(均P<0.05),CA19-9和AFP水平在实验组、良性肿瘤对照组和健康人对照组之间无统计学差异(均P>0.05);早期(Ⅰ期+Ⅱ期)口腔/口咽鳞癌患者血清Cyfra 21-1水平明显高于良性肿瘤对照组和健康人对照组(均P<0.05),但血清SCCAg、Ferritin、CEA、CA19-9、AFP水平分别与良性肿瘤对照组和健康人对照组无统计学差异(均P>0.05);中晚期(Ⅲ期+Ⅳ期)口腔/口咽鳞癌患者血清Cyfra 21-1、SCCAg、Ferritin和CEA水平分别明显高于早期口腔/口咽鳞癌患者、良性肿瘤对照组和健康人对照组(均P<0.05);Cyfra 21-1的ROC曲线下面积最大(AUC=0.748,95%CI=0.692~0.805),SCCAg、CEA和Ferritin的ROC曲线下面积依次减小(AUC分别为0.708,0.669,0.627,95%CI分别为0.647~0.768,0.605~0.733,0.561~0.692);Cyfra 21-1的诊断临界点为2.17 ng/m L,敏感性为60.36%,特异性为81.03%;口腔/口咽鳞癌的分化程度越高,Cyfra 21-1的血清水平越低(rs=-0.223,P=0.004)。结论:在Cyfra 21-1、SCCAg、Ferritin、CEA、CA19-9和AFP 6种血清肿瘤标志物中,Cyfra 21-1和SCCAg对口腔/口咽鳞癌的诊断优于其他标志物,同时Cyfra 21-1对口腔/口咽鳞癌具有较好的早期诊断价值,而CA19-9和AFP对口腔/口咽鳞癌没有诊断价值。
Objective: To investigate the relationship between serum tumor markers Cytokeratin 19 fragment (Cyfra 21-1), squamous cell carcinoma antigen (SCCAg), Ferritin, carcino-embryonic (CEA), Carbohydrate antigen (CA19-9) and alpha-fetoprotein (AFP) in the diagnosis of oral / oropharyngeal squamous cell carcinoma. Methods: A total of 169 patients with oral / oropharyngeal squamous cell carcinoma were selected as experimental group, 86 benign tumor patients as benign tumor control group and 30 healthy volunteers as healthy control group. Electrochemiluminescence immunoassay (ECLIA) The levels of serum Cyfra 21-1, SCCAg, Ferritin, CEA, CA19-9 and AFP in each group were detected. The data were processed by SPSS 21.0 statistical software and analyzed by ROC (receiver operator characteristic) curve. Results: Serum levels of Cyfra 21-1, SCCAg, Ferritin and CEA in the experimental group were significantly higher than those in the benign tumor control group and healthy control group (all P <0.05). The levels of CA19-9 and AFP in the experimental group, benign tumor control group (P> 0.05). The serum level of Cyfra 21-1 in patients with early stage (stage I + II) oral / oropharyngeal squamous cell carcinoma was significantly higher than that in benign tumor control group and healthy control group (All P <0.05). However, the levels of serum SCCAg, Ferritin, CEA, CA19-9 and AFP were not significantly different from those of benign tumor control group and healthy control group (all P> 0.05) Ⅳ) The serum levels of Cyfra 21-1, SCCAg, Ferritin and CEA in oral / oropharyngeal squamous cell carcinoma were significantly higher than those in early oral / oropharyngeal squamous cell carcinoma, benign tumor control group and healthy human control group (all P <0.05) ; The area under the ROC curve of Cyfra 21-1 was the largest (AUC = 0.748, 95% CI = 0.692-0.805). The area under the ROC curve of SCCAg, CEA and Ferritin decreased in turn (AUC 0.708,0.669,0.627,95% CI 0.647 ~ 0.768,0.605 ~ 0.733,0.561 ~ 0.692, respectively). The diagnostic limit of Cyfra 21-1 was 2.17 ng / m L, with a sensitivity of 60.36% and a specificity of 81.03% The higher the degree of differentiation of oral / oropharyngeal squamous cell carcinoma, the lower the serum level of Cyfra 21-1 (rs = -0.223, P = 0.004). CONCLUSIONS: Cyfra 21-1 and SCCAg are superior to other markers in the diagnosis of oral / oropharyngeal squamous cell carcinoma in serum markers of Cyfra 21-1, SCCAg, Ferritin, CEA, CA19-9 and AFP. Cyfra 21-1 has good early diagnostic value for oral / oropharyngeal squamous cell carcinoma, while CA19-9 and AFP have no diagnostic value for oral / oropharyngeal squamous cell carcinoma.