Clinical Significance Of Abnormal Levels Of Serum Tumor Markers In Patients With Axial Spondyloarthritis

Background and objective:The levels of serum tumor markers are a reference index for evaluating the diagnosis and treatment of malignant tumors.Current research shows that patients with rheumatic diseases have a significantly higher risk of malignant tumors than the general population In order to evaluate whether patients with rheumatic diseases are complication of malignant tumors,the levels of serum tumor markers,and relative laboratory examinations and imaging examinations are often performed.However,abnormal levels of serum tumor markers were also shown in some patients with axial spondyloarthritis(ax-SpA)without complication of malignant tumors during clinical diagnosis and treatment.We aim to investigate the clinical significance of abnormal levels of serum tumor markers,such as CA199,AFP,CEA,NSE,CA72-4 and proGRP in ax-SpA patients.Furthermore,the relationship between serum NSE levels and neuropathy in ax-SpA patients were also explored.Methods:A total of 348 patients with ax-SpA were enrolled in this study.Serum levels of tumor markers and clinical data of the 348 patients with ax-SpA were collected.On the one hand,ax-SpA patients were divided into normal tumor markers group and abnormal tumor markers group according to normal and abnormal serum levels of tumor markers in patients,and the general data and disease activity were analyzed to compare the differences between the two groups.On the other hand,ax-SpA patients were divided into BASDAI<4 group and BASDAI≥4 group based on BASDAI,and the relationship between serum levels of tumor markers and disease severity in patients were analyzed.Logistic regression analysis was used to analyze the risk factors resulted in abnormal serum levels of tumor markers in ax-SpA patients.Meanwhile,the general data of ax-SpA patients with abnormal serum levels of tumor markers before and after treatment were collected to analyze the changes in disease activity and the levels of tumor markers.Furthermore,the ROC curve was drawn to evaluate the diagnostic function of NSE levels in ax-SpA patients with neuropathy.Results:1.Abnormal serum levels of tumor markers including CA199,AFP,CEA,NSE,CA72-4 and proGRP were shown in 85 patients in 348 ax-SpA patients(24.43%).Among them,abnormal serum levels of CA199,AFP,CEA,NSE,CA72-4 and proGRP were shown in 7 cases(8.24%),3 cases(3.53%),10 cases(11.76%),59 cases(69.41%),14 cases(16.47%)and 5 cases(5.88%),respectively.2.A significant increase in the risk of abnormal serum levels of tumor markers in male ax-SpA patients(81.18%vs 66.92%),ax-SpA patients with neuropathy(60.00%vs 22.05%)and with diabetes(7.06%vs 0.76%)was shown(P<0.05),when compared with those in the normal tumor markers group.Meanwhile,our data also demonstrated that the levels of serum alanine transaminase,creatinine,cystatin C and IgA were significantly increased,and the levels of serum C3 and IgG were decreased in the abnormal tumor markers group compared to those in normal tumor markers group(P<0.05).3.The serum levels of ESR,CRP,BASDAI,ASDAS-ESR and ASDAS-CRP of ax-SpA patients in abnormal tumor markers group were significantly higher than in normal tumor markers group(P<0.05),but there was no significant alteration of the serum BASMI between the two groups(P>0.05).Moreover,we showed that the levels of serum CA199 in ax-SpA patients with BASDAI<4 were significantly decreased in comparison to that in ax-SpA patients with BASDAI>4(7.26±5.83 U/mL vs 9.80±10.13 U/mL,P<0.05).Furthermore,our data demonstrated that the abnormal levels of serum CA199 is related to the severity of disease in patients with ax-SpA.4.Binary Logistic multivariate regression analysis showed that BASDAI,complication of neuropathy and diabetes(P<0.05)are risk factors for abnormal serum tumor markers in ax-SpA patients.5.85 ax-SpA patients with abnormal serum tumor markers participated in the follow-up for 6 months.Our data showed that the levels of serum tumor markers in ax-SpA patients were also reduced when the disease activity index(ESR,CRP and BASDAI)significantly decreased after treatment(P<0.001).6.The levels of serum NSE in ax-SpA patients with neuropathy were significantly higher than in those without neuropathy(16.62±0.86 ng/mL vs 12.19±0.20 ng/mL,P<0.001).Data from the ROC curve showed that the areas under the curve of NSE was 0.738(95%Cl 0.680～0.797,P<0.001),suggesting that the levels of NSE might be a valuable marker for predicting ax-SpA patients with neuropathy.Conclusion:Abnormal serum levels of CA199,AFP,CEA,NSE,CA72-4 and proGRP were found in ax-SpA patients(24.43%),and are related to disease activity in ax-SpA patients.The serum levels of CA199 are related to the severity of disease in patients with ax-SpA.The disease activity(BASDAI),complication of neuropathy and diabetes are risk factors for serum tumor marker abnormalities in ax-SpA patients.The levels of NSE is valuable marker in predicting ax-SpA patients with neuropathy.