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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2021, Vol. 14 ›› Issue (02) : 141 -145. doi: 10.3877/cma.j.issn.1674-6902.2021.02.002

论著

癌胚抗原在不同驱动基因肺癌患者中的差异性
张红军1, 苏尉2, 顾兴1, 金发光2, 戚刚强1,†()   
  1. 1. 710100　西安，西安市胸科医院；710038　西安，空军（第四）军医大学唐都医院呼吸与危重症医学科
    2. 710038　西安，空军（第四）军医大学唐都医院呼吸与危重症医学科
  • 收稿日期:2020-08-25 出版日期:2021-04-25
  • 通信作者: 戚刚强
  • 基金资助:
    国家自然科学基金资助项目(81071933)

Explore the difference of carcinoembryonic antigen in lung cancer patients with different driving gene

Hongjun Zhang1, Wei Su2, Xing Gu1, Faguang Jin2, Gangqiang Qi1,†()   

  1. 1. Department of Respiratory and Critical Care Medicine, Xi′an Chest Hospital, Xi′an710100, China; Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi′an 710038, China
    2. Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi′an 710038, China
  • Received:2020-08-25 Published:2021-04-25
  • Corresponding author: Gangqiang Qi
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引用本文：

张红军, 苏尉, 顾兴, 金发光, 戚刚强. 癌胚抗原在不同驱动基因肺癌患者中的差异性[J]. 中华肺部疾病杂志(电子版), 2021, 14(02): 141-145.

Hongjun Zhang, Wei Su, Xing Gu, Faguang Jin, Gangqiang Qi. Explore the difference of carcinoembryonic antigen in lung cancer patients with different driving gene[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(02): 141-145.

目的

通过回顾性分析不同驱动基因肺癌患者的血清癌胚抗原(CEA)水平，探讨CEA在不同驱动基因肺癌患者中的差异性。

方法

选择2015年9月至2018年12月唐都医院呼吸与危重症医学科经治的210例肺癌患者，分别采用电化学发光免疫分析法和探针扩增阻滞突变系统聚合酶链反应法检测CEA水平及基因突变状况，分析不同驱动基因肺癌患者的CEA水平。

结果

存在基因突变的肺癌患者以女性为主(52.46%)，而无基因突变的肺癌患者则以男性为主(67.39%)，差异具有统计学意义(P＝0.004)。基因突变的肺癌患者CEA水平11.43(4.32～46.82) ng/ml明显高于无基因突变的肺癌患者4.52(2.07～14.87) ng/ml(P<0.001)，而E19Del、L858R、KRAS、EML4-ALK和ROS1，以及组合突变和少见突变等各靶点的不同肺癌患者CEA水平之间并没有明显差异性(P均>0.05)。将基因检测阳性的肺癌患者按EGFR组、KRAS组、EML4-ALK组及ROS1组进一步分析，发现KRAS组以男性为主(76.47%)，EML4-ALK组则以女性为主(90.91%)，这两组之间存在明显的性别差异性(P＝0.007)；而四组在年龄及CEA水平方面并没有明显差异性(P均>0.05)。

结论

肺癌患者的CEA水平对基因检测阳性和阴性具有一定的预测价值，但是它对基因检测阳性肺癌患者的敏感靶点并没有预测价值。

关键词: 支气管肺癌, 癌胚抗原, 基因突变
Objective

Level of the carcinoembryonic antigen(CEA) was studied in lung cancer patients with different driving gene, to explore the difference of their CEA .

Methods

All 210 cases of patients with lung cancer were recruited in Department of Respiratory and Critical Care Medicine Tang Du Hospital. CEA was measured by Electro-Chemiluminescence Immunoassay (ECLI). And their mutations were measured by amplification refractory mutation system (ARMS). Then the CEA of lung cancer patients with different driving gene was analyzed.

Results

The majority of lung cancer patients with gene mutation were female (52.46%), while those without gene mutation were mainly male (67.39%). The difference was statistically significant (P=0.004) in them. The CEA level in lung cancer patients with gene mutation [11.43 (4.32~46.82) ng/ml] was significantly higher than that in patients without gene mutation [4.52 (2.07~14.87) ng/ml] (P<0.001), while there was no significant difference in CEA levels among patients with different mutations such as e19del, L858R, KRAS, EML4-ALK and ROS1, as well as combination mutation and rare mutation (P>0.05). Then, the lung cancer patients with positive gene detection were divided into EGFR group, KRAS group, EML4-ALK group and ROS1 group. Further analysis found that the majority of lung cancer patients in KRAS group were male (76.47%), while EML4-ALK group was mainly female (90.91%). There was significant gender difference between the KRAS group and EML4-ALK group (P=0.007), but there was no significant difference in age and CEA level among the four groups (P>0.05).

Conclusion

Although the serum CEA can probably serve as marker of prediction mutations in patients with lung cancer, it has no predictive value for sensitive targets for genetically positive lung cancer patients.

Key words: Bronchogenic carcinoma, Carcinoembryonic antigen, Mutation
表1 基因检测阳性和阴性肺癌患者的性别及年龄、CEA比较[n(%)]
组　别 性　别 年龄 CEA(ng/ml)
男 女 <60岁 ≥60岁
基因检测 + 56(47.46) 62(52.54) 54(45.76) 64(54.24) 11.43(4.32～46.82)
  - 62(67.39) 30(32.61) 43(46.74) 49(53.26) 4.52(2.07～14.87)
χ2值   8.344 0.02 14.55
P值   0.004 0.888 <0.001
表2 不同驱动基因的肺癌患者基本特征和CEA比较
临床资料   例数 CEA(ng/ml) χ2值 P值
性别 男 56 10.97(4.26～96.48) 0.314 0.575
  女 62 12.95(4.36～36.01)    
年龄 <60岁 54 9.69(4.41～31.15) 0.334 0.563
  ≥60岁 64 12.95(4.23～90.06)    
病理类型 腺癌 100 10.97(4.33～52.82) 0.187 0.666
  未分类癌 17 25.74(6.09～40.97)    
  鳞癌 1 2.37    
驱动基因 E19Del 40 11.08(2.82～69.12) 0.729 0.393
  L858R 28 18.79(7.59～124.90)    
  L861Q 3 101.04    
EGFR S768I 1 11.27    
  G719X+L861Q 2 6.32    
  E19Del+T790M 3 209.36    
  L858R+790M 3 97.53    
  L858R+G719X 1 7.86    
KRAS   17 4.90(2.72～19.39) 0.471 0.79
EML4-ALK   11 3.67(1.74～36.92)    
ROS-1   6 5.54(3.58～432.3)    
EML4-ALK+ROS-1   3 24.97    
表3 存在主要驱动基因的肺癌患者性别及年龄、CEA比较[n(%)]
组　别 性别 年龄 CEA(ng/ml)
男 女 <60岁 ≥60岁
EGFR 38(46.91) 43(53.09) 38(46.91) 43(53.09) 16.66(4.71～68.71)
KRAS 13(76.47) 4(23.53) 6(35.29) 11(64.71) 4.90(2.72～19.39)
EML4-ALK 1(9.09) 10(90.91) 5(45.45) 6(54.55) 3.67(1.74～36.92)
ROS-1 3(50.00) 3(50.00) 3(50.00) 3(50.00) 5.54(3.58～432.3)
χ2值 12.243 0.826 4.998
P值 0.007 0.843 0.172
1
钱桂生. 肺癌不同病理类型发病率的变化情况及其原因[J/CD]. 中华肺部疾病杂志(电子版), 2011, 4(1): 1-5.
2
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016[J]. CA Cancer J Clin, 2016, 66(1): 7-30.
3
Fidler MM, Bray F, Soerjomataram I. The global cancer burden and human development: A review[J]. Scand J Public Health, 2018, 46(1): 27-36.
4
Olaussen KA, Dunant A, Fouret P, et al. DNA repair by ERCC1 in non-small-cell lung cancer and cisplatin-based adjuvant chemotherapy[J]. N Engl J Med, 2006, 355(10): 983-991.
5
霍婷婷，贾金虎. EGFR基因检测在非小细胞肺癌诊疗应用中的新进展[J]. 癌症进展，2016, 14(6): 507-509, 513.
6
Chen G, Kronenberger P, Teugels E, et al. Effect of siRNAs targeting the EGFR T790M mutation in a non-small cell lung cancer cell line resistant to EGFR tyrosine kinase inhibitors and combination with various agents[J]. Biochem Biophys Res Commun, 2013, 431(3): 623-629.
7
孙　虎，张俊萍. 晚期非小细胞肺癌靶向治疗研究进展[J/CD]. 中华临床医师杂志(电子版), 2016(2): 264-269.
8
章建东，刘凤奎. 对非肿瘤患者的肿瘤标志物升高的诊断[J]. 中国医刊，2014, 49(2): 17-18.
9
Abdurahman A, Anwar J, Turghun A, et al. Epidermal growth factor receptor gene mutation status and its association with clinical characteristics and tumor markers in non-small-cell lung cancer patients in Northwest China[J]. Mol Clin Oncol, 2015, 3(4): 847-850.
10
Yamaguchi K, Katagiri H, Takahashi M, et al. ProGRP is a possible tumor marker for patients with Ewing sarcoma[J]. Biomed Res, 2015, 36(4): 273-277.
11
张红军，顾　兴，刘　伟，等. 肿瘤标志物动态变化在肺癌疗效判断与随访中的意义[J/CD]. 中华肺部疾病杂志(电子版), 2016, 9(1): 26-30.
12
温仁祝，戴　磊，张亚男. 原发性非小细胞肺癌EGFR基因与肿瘤抗原标志物检测的临床意义[J]. 广西医科大学学报，2015, 32(2): 267-268.
13
徐韫健，高　俊，林勇平，等. ARMS法在检测肺癌晚期患者肿瘤组织和血浆表皮生长因子受体基因突变中的应用[J]. 广东医学，2016(14): 2157-2159.
14
Lynch TJ, Bell DW, Sordella R, et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib[J]. N Engl J Med, 2004, 350(21): 2129-2139.
15
吕艳玲，袁冬梅，宋　勇，等. 肺腺癌患者血清及胸水CEA与EGFR突变的相关性研究[J]. 临床肿瘤学杂志，2016, 21(7): 621-625.
16
Cho A, Hur J, Moon YW, et al. Correlation between EGFR gene mutation, cytologic tumor markers, 18F-FDG uptake in non-small cell lung cancer[J]. BMC Cancer, 2016, 16: 224.
17
郭万峰，刘晓晴，苏剑斌. 非小细胞肺癌EGFR-TKIs耐药-小细胞肺癌转化的机制和治疗[J]. 临床肿瘤学杂志，2016, 21(4): 368-371.
18
Zhou J, Song XB, He H, et al. Prevalence and clinical profile of EGFR mutation in non-small-cell lung carcinoma patients in southwest China[J]. Asian Pac J Cancer Prev, 2016, 17(3): 965-971.
19
Shigematsu H, Lin L, Takahashi T, et al. Clinical and biological features associated with epidermal growth factor receptor gene mutations in lung cancers[J]. J Natl Cancer Inst, 2005, 97(5): 339-346.
20
Soda M, Choi YL, Enomoto M, et al. Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer[J]. Nature, 2007, 448(7153): 561-566.
21
苗　参. BAMBI在非小细胞肺癌中的表达[D]. 沈阳：中国医科大学，2007: 43-65.
22
刘延梅，马　庆，张　静. EGFR及IGF1R在非小细胞肺癌(NSCLC)中表达及临床意义的研究[J]. 临床肺科杂志，2019, 24(5): 874-877.
23
Sasaki T, Rodig SJ, Chirieac LR, et al. The biology and treatment of EML4-ALK non-small cell lung cancer[J]. Eur J Cancer, 2010, 46(10): 1773-1780.
24
Lv Y, Miao LY, Chen QF, et al. Monitoring of high-density lipoprotein cholesterol level is predictive of EGFR mutation and efficacy of EGFR-TKI in patients with advanced lung adenocarcinoma[J]. Onco Targets Ther, 2016, 9: 461-468.
25
邱　英，张为民. ALK-TKIs治疗非小细胞肺癌的研究进展[J]. 临床医学研究与实践，2019, 4(19): 187-190.
26
张红军，房延凤，苏　尉，等. 癌胚抗原对肺癌患者基因突变状况的预测价值[J]. 肿瘤药学，2017, 7(5): 545-550.
27
Gold P, Freedman SO. Demonstration of tumor-specific antigens in human colonic carcinomataA by immunological tolerance and absorption techniques[J]. J Exp Med, 1965, 121: 439-462.
28
Higashi K, Sakuma T, Ito K, et al. Combined evaluation of preoperative FDG uptake on PET, ground-glass opacity area on CT, and serum CEA level: identification of both low and high risk of recurrence in patients with resected T1 lung adenocarcinoma[J]. Eur J Nucl Med Mol Imaging, 2009, 36(3): 373-381.
29
靳　璐，何志光，李　震. 耐药NSCLC患者采用培美曲塞联合EGFR-TKI治疗的效果及对血清Ang2、VEGF、MMP9水平的影响[J]. 临床肺科杂志，2019, 24(5): 930-933.
30
潘炯伟，曹　卓. 肺癌的常见肿瘤标志物和基因检测进展(文献综述)[J]. 放射免疫学杂志，2013, 25(3): 292-296.
31
蒋贝兰，沙　杭. 肺癌血清肿瘤标志物的研究现状及进展[J]. 天津医药，2014, 42(4): 393-395.
32
王会中，任成山，金发光. 肿瘤生物标志物在肺癌患者检测中的临床意义及研究进展[J/CD]. 中华肺部疾病杂志(电子版), 2016, 9(3): 329-333.
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