摘要
目的研究胰腺癌诊断中常用血清肿瘤标志物之间的互补性,探讨最佳单项和组合指标确立的依据。方法分析CA242、CA19-9、CA15-3、CA125、CA50和CEA6个指标在315例胰腺癌和181例良性疾病中相互之间的Spearman相关性,计算各指标ROC曲线下面积并进行Logistic回归分析,按照试剂盒提供的参考值计算肿瘤标志物单一和组合分析时的诊断参数。结果单一肿瘤标志物以CA242和CA19-9的ROC曲线下面积(0.78vs0.76,P=0.195)最大;除了CA242与CEA和CA15-3之间各不相关外(P>0.05),其他所有指标两两之间均显著相关(P<0.01)。回归分析只有CA242和CEA被纳入回归方程(P<0.05),样本分类准确率达81.5%;两指标并联后的Youden指数(0.51)在所有单项和组合分析中最大,与CA242单项比较,敏感性和特异性均有升高趋势但无显著差异(P>0.05)。结论ROC曲线和Logistic回归是确立最佳单项和组合指标的合理统计分析方法;不相关指标之间互补性强,成为优化组合的基础;胰腺癌诊断中以CA242和CA19-9单项或CA242+CEA联合分析为首选。
Objective To study the complementarity of serum tumor markers measurement, so as to find the best single item and their optimal combination in diagnosis of pancreatic carcinoma. Methods Spearman correlation, binary logistic regression and ROC curve was performed on 6 serum tumor markers measurements in 315 patients with pancreatic carcinoma and 181 benign diseases. Diagnostic parameters of the tumor markers were calculated according to reference values recommended by the kits. Results Both CA242 and CA19-9 had the largest area under the ROC curve （0.78 vs 0. 76, P = 0. 195） among the 6 tumor markers. Significant correlation was found between all tumor markers （P 〈0.0l） , except between CA242 and CEA or CA15-3 （P 〉 0.05）. Only CA242 and CEA were included in the model of logistic regression, reached an accuracy of 81.5% , and obtained the largest Youden index （0.51） among all combination patterns, but had insignificant increase in both sensitivity and specificity in comparison with CA242 alone （P 〉 0.05）. Conclusion ROC curve and logistic regression are reseanable statistical approaches to specify the best and optimal single or combined tumor markers in a certain malignancy. There was good complementarity among uncorrelated tumor markers and thus forms strong evidence for optimal combination. CA242 and CA19-9 alone or CA242 ＋ CEA should be first choice measurement in diagnosis of pancreatic carcinoma
出处
《上海第二医科大学学报》
CSCD
北大核心
2005年第12期1239-1241,共3页
Acta Universitatis Medicinalis Secondae Shanghai
关键词
肿瘤标志物
互补性
胰腺癌
血清
tumor markers
complementarity
pancreatic carcinoma
