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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
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