Diagnostic value of tumor-associated autoantibodies for malignant pulmonary nodules
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摘要:
目的 评价一组肿瘤相关自身抗体（tumor-associated autoantibodies，T-AABs），包括p53、PGP9.5、SOX2、GAGE7、GBU4-5、MAGE-A1和CAGE，在恶性肺结节中的诊断价值，评估7-AABs与肿瘤标志物血清癌胚抗原（carcinoembryonic antigen，CEA）、神经元特异性烯醇化酶（neuron specific enolase，NSE）、细胞角蛋白19片段21-1（cytokeratin 19 fragment 21-1，CYFRA 21-1）水平和Mayo模型联合诊断恶性肺结节的价值，并分析7-AABs与CT影像学征象的相关性。 方法 选取东南大学附属中大医院2016年12月至2019年02月经手术取得的208例肺结节患者病理结果。采用酶联免疫吸附试验（enzyme-linked immunosorbent assay，ELISA）检测血浆AABs水平，同时对比并结合CEA、NSE、CYFRA 21-1和Mayo模型，分析其在恶性肺结节诊断中的价值。采用χ2检验或t检验分析AABs阳性表达与CT征象的相关性。 结果 7-AABs在恶性肺结节中的敏感性、特异性和阳性预测值（positive predictive value，PPV）分别为54.7%、87.9%和92.1%。7-AABs与肿瘤标志物联合检测的敏感性高达70.0%。7-AABs与Mayo模型联合诊断恶性肺结节的曲线下面积（AUC）为0.699。7-AABs阳性表达与短毛刺征、空泡征具有相关性（均P < 0.05）。 结论 7-AABs水平对良恶性肺结节的鉴别有一定价值，联合肿瘤标志物、Mayo模型检测可提高恶性肺结节的诊断效能，7-AABs阳性表达与短毛刺征、空泡征相关，可能有助于良恶性肺结节的鉴别。 Abstract:Objective We aimed to determine the diagnostic value of tumor-associated autoantibodies (T-AABs), namely, p53, PGP9.5, SOX2, GAGE7, GBU4-5, MAGE-A1, and CAGE; this 7-AAB panel is known to be helpful in diagnosing malignant pulmonary nodules. The diagnostic value of 7-AABs in combination with tumor markers serum carcinoembryonic antigen (CEA), neuron specific enolase (NSE), cytokeratin 19 fragment 21-1 (CYFRA 21-1) and the Mayo model in malignant lung nodules was evaluated separately, and the correlation between 7-AABs and CT imaging signs was also studied. Methods A total of 208 patients with pulmonary nodules and surgical pathology results admitted to the Zhongda Hospital of Southeast University from December 2016 to February 2019 were enrolled in this study. The levels of plasma AABs were evaluated using enzyme-linked immunosorbent assay (ELISA). The value of 7-AABs in the diagnosis of malignant lung nodules was evaluated by comparing and combining the results of tumor markers and the Mayo model. The Chi-square test or t-test was used to determine the correlation between 7-AABs and the CT imaging signs of the patients. Results The sensitivity, specificity, and positive predictive value (PPV) of 7-AABs were 54.7%, 87.9% and 92.1%, respectively. The sensitivity of 7-AABs was increased to 70.0% when combined with tumor markers. The area under the curve (AUC) of 7-AABs in combination with the Mayo model in the diagnosis of malignant pulmonary nodules was 0.699. The expression of 7-AABs was found to be positively correlated with spicule and vacuole signs (P < 0.05, respectively). Conclusions Determination of plasma AABs levels is crucial for the differentiation of benign and malignant pulmonary nodules. Additionally, the diagnostic efficacy of 7-AABs is improved when combined with tumor markers and the Mayo model during the diagnosis of malignant pulmonary nodules. The expression of 7-AABs is positively correlated with spicule and vacuole signs, which might further assist in the differential diagnosis of benign and malignant lung nodules. -
表 1 患者的一般资料
表 2 7-AABs与单个自身抗体的Sens、Spec和PPV比较
表 3 7-AABs在不同肺癌分期、结节大小和密度中的敏感性和PPV比较
表 4 7-AABs与肿瘤标志物的敏感性、特异性和PPV比较
表 5 Mayo模型联合7-AABs与Mayo模型、7-AABs的比较
表 6 7-AABs阳性表达与CT征象的相关性
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