血清CA724联合CYFRA 21-1对ⅢA-N2期非小细胞肺癌N2淋巴结跳跃转移的评估价值

The evaluation value of serum CA724 combined with CYFRA 21-1 in assessing N2 lymph node skip metastasis in stage ⅢA-N2 non-small cell lung cancer

摘要:

目的 分析血清糖类抗原724（CA724）联合细胞角蛋白19片段（CYFRA 21-1）对ⅢA-N2期非小细胞肺癌（NSCLC）N2淋巴结跳跃转移的评估价值。方法 回顾性分析2022年8月—2024年8月沧州市人民医院收治的102例ⅢA-N2期NSCLC患者的临床资料，根据是否发生N2淋巴结跳跃转移分为跳跃转移组（28例）和非跳跃转移组（74例）。检测比较患者血清CA724、CYFRA 21-1水平；采用受试者工作特征（ROC）曲线评估CA724联合CYFRA 21-1对ⅢA-N2期NSCLC患者N2淋巴结跳跃转移的预测价值；采用多因素逐步Logistic回归分析其独立影响因素。结果 跳跃转移组与非跳跃转移组病理类型构成、肿瘤最大直径构成、N2转移站数构成、EGFR突变率和CA125、CA724、CYFRA 21-1水平比较，差异均有统计学意义（P <0.05）；跳跃转移组腺癌占比、肿瘤最大直径<3 cm占比、单站N2转移占比和EGFR突变率均高于非跳跃转移组，CA125、CA724和CYFRA 21-1水平低于非跳跃转移组。在最佳截断值下，CA724预测ⅢA-N2期NSCLC N2淋巴结跳跃转移的曲线下面积为0.842（95% CI：0.792，0.892），敏感性为89.91%（95% CI：0.789，1.000），特异性为62.03%（95% CI：0.510，0.730）；CYFRA 21-1预测ⅢA-N2期NSCLC N2淋巴结跳跃转移的曲线下面积为0.855（95% CI：0.805，0.905），敏感性为89.91%（95% CI：0.789，1.000），特异性为66.74%（95% CI：0.559，0.775）；两者联合预测ⅢA-N2期NSCLC N2淋巴结跳跃转移的曲线下面积为0.908（95% CI：0.858，0.958），敏感性为84.11%（95% CI：0.700，0.932），特异性为88.71%（95% CI：0.805，0.945）。多因素逐步Logistic回归分析显示，单站N2转移［O^R =2.349（95% CI：1.584，3.483）］、EGFR突变阳性［O^R =5.275（95% CI：2.197，12.669）］、血清CA125水平低［O^R =0.413（95% CI：0.272，0.628）］、CA724水平低［O^R =0.328（95% CI：0.174，0.621）］和CYFRA 21-1水平低［O^R =0.256（95% CI：0.135，0.487）］均为ⅢA-N2期NSCLCN2淋巴结跳跃转移的危险因素（P <0.05）。结论 血清CA724、CYFRA 21-1水平降低与ⅢA-N2期NSCLC N2淋巴结跳跃转移风险增加密切相关；CA724和CYFRA 21-1对N2淋巴结跳跃转移发生具有一定预测效能，且两者联合可进一步提高预测效能。

Abstract:

Objective To analyze the evaluation value of serum carbohydrate antigen 724 (CA724) combined with cytokeratin 19 fragment (CYFRA 21-1) in assessing N2 lymph node skip metastasis in patients with stage ⅢA-N2 non-small cell lung cancer (NSCLC).Methods The clinical data of 102 patients with stage ⅢA-N2 NSCLC admitted to Cangzhou People's Hospital from August 2022 to August 2024 were retrospectively analyzed. They were divided into the skip metastasis group (28 cases) and the non-skip metastasis group (74 cases) according to whether N2 lymph node skip metastasis occurred. The serum levels of CA724 and CYFRA 21-1 were detected and compared between the two groups. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of CA724 combined with CYFRA 21-1 for N2 lymph node skip metastasis in stage ⅢA-N2 NSCLC patients, and multivariate stepwise Logistic regression analysis was used to identify its independent influencing factors.Results There were statistically significant differences in pathological type composition, maximum tumor diameter composition, N2 metastasis station composition, EGFR mutation rate, and levels of CA125, CA724, and CYFRA 21-1 between the skip metastasis group and the non-skip metastasis group (all P < 0.05). The proportion of adenocarcinoma, proportion of maximum tumor diameter < 3 cm, proportion of single-station N2 metastasis, and EGFR mutation rate in the skip metastasis group were higher than those in the non-skip metastasis group, while the levels of CA125, CA724, and CYFRA 21-1 were lower than those in the non-skip metastasis group. At the optimal cut-off value, the area under the curve (AUC) of CA724 for predicting N2 lymph node skip metastasis in stage ⅢA-N2 NSCLC was 0.842 (95% CI: 0.792, 0.892), with a sensitivity of 89.91% (95% CI: 0.789, 1.000) and a specificity of 62.03% (95% CI: 0.510, 0.730). The AUC of CYFRA 21-1 for predicting N2 lymph node skip metastasis in stage ⅢA-N2 NSCLC was 0.855 (95% CI: 0.805, 0.905), with a sensitivity of 89.91% (95% CI: 0.789, 1.000) and a specificity of 66.74% (95% CI: 0.559, 0.775). The AUC of the combined detection of CA724 and CYFRA 21-1 for predicting N2 lymph node skip metastasis in stage ⅢA-N2 NSCLC was 0.908 (95% CI: 0.858, 0.958), with a sensitivity of 84.11% (95% CI: 0.700, 0.932) and a specificity of 88.71% (95% CI: 0.805, 0.945). Multivariate stepwise Logistic regression analysis showed that single-station N2 metastasis [O^R = 2.349 (95% CI: 1.584, 3.483) ], positive EGFR mutation [O^R = 5.275 (95% CI: 2.197, 12.669) ], low serum CA125 level [O^R = 0.413 (95% CI: 0.272, 0.628) ], low CA724 level [O^R = 0.328 (95% CI: 0.174, 0.621) ], and low CYFRA 21-1 level [O^R = 0.256 (95% CI: 0.135, 0.487) ] were all risk factors for N2 lymph node skip metastasis in stage ⅢA-N2 NSCLC (all P < 0.05).Conclusion Decreased serum levels of CA724 and CYFRA 21-1 are closely related to an increased risk of N2 lymph node skip metastasis in stage ⅢA-N2 NSCLC. Both CA724 and CYFRA 21-1 have certain predictive efficacy for the occurrence of N2 lymph node skip metastasis, and their combination can further improve the predictive efficacy.