The Clinical Study Of ADAM8, TPS, CEA As Serum Tumor Markers In Lung Carcinoma

Objectives:1. To study and compare the diagnostic value of 5 tumor markers(TM) for lung carcinoma: carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125) carbohydrate antigen 199(CA199),a disintegrin and metalloprotease 8(ADAM8),tissue polypeptide-specific antigen(TPS) in lung carcinoma,and the relationship between TM and patients'age, gender, pathological types and clinical stages.2. To study the value of TM combined detection and the clinical significance of TM in lung carcinoma:(1) To study and compare the diagnostic value of combined detection for lung cancer, and to affirm which was the TM combination with better diagnostic effect.(2) To observe TM serum level changes before and after chemotherapy, to quantify the TM changes as the standerd for chemotherapy response evaluation, and discuss its significance in the regimin of chemotherapy with platinum treatment.Method: According to different admitted standerds for each research, the in-patients in Oncology and respiratory departments who were pathologically diagnosed as lung cancer during 2009 to 2010 were KPS scored ,and divided into different groups by age, gender, TNM stages, pathological types and RESIST2009 standerd.The serum levels of TM were detected and all the data was analysed by SAS9.1 package.Results:1. The diagnostic values of tumor markers:1.1 The correlation between the serum levels of TM and the patients'age, gender: the 118 patients were divided into 3 groups by age such as group A(≥70,n=24), group B(50-70,n=53), group B(50-70,n=53),group C(≤50,n=39).There was no significant difference of the 5 tumor markers among the three groups(P>0.05).Divided by gender,there was no significant difference between females and males(P>0.05).1.2 The serum levels of TM in groups of lung cancer and the control:the serum levels of CEA,CA125,CA199,ADAM8,TPS increased significantly in group lung cancer,comparing with group PBD and the healthy(P<0.01).There was no significant difference between the latter two groups(P>0.05).1.3 The positives rate of every TM in group LC, group PBD and the healthy control:the positive rates of tumor markers in group LC were significantly different from those in healthy control and group PBD(P<0.05).There was significant difference among the positive rates of 5 tumor markers(P=0.034).The positive rate of ADAM8 was the highest which was 79.7%(94/118).The positive rate of CA199 was the lowest which was 24.6%(29/118).1.4 The serum levels of tumor markers in different pathological types:the serum level of CEA increased significantly in group adenocarcinoma comparing with the other two groups(P<0.05).While there was no significant differences in the serum levels of TPS,ADAM8,CA125,CA199 among different pathological types(P>0.05).1.5 The positive rates of TM in different pathological types:Among the groups of adenocarcinoma, squamous carcinoma, small cell carcinoma, there was significant difference in the positive rate of CEA(P<0.05).The positive rate was the higest in adenocarcinoma which was 66.1%(41/62).1.6 The positive rates of TM in different stages: the positive rates of TM increased with the clinical stages, the positive rates of 5 tumor markers were significantly different among TNM stages,which is significantly higher in stage I,II than in stage III,IV(P<0.05).The positive rates of ADAM8 in stage I,II was significantly higher than those in group PBD(P=0.0014). There was no significant difference for the positive rates of other tumor markers between stage I,II and the group PBD(P>0.05).1.7 The serum levels of 5 tumor markers in clinical stages: the serum levels increased with the TNM stage, the difference among TNM stages was significant(P<0.05).The serum levels in stage III,IV increased significantly comparing with those in stage I,II(P<0.05).In stage I,II, the serum level of ADAM8 was significantly higher than that in group PBD(P<0.05).2.Combined detection and the value of serum tumor markers in treatment:2.1 The diagnostic value of single and combined detection: Comparing the diagnostic effects of ADAM8,TPS,CEA in single detection, the Youden index and the area under the ROC were 0.773 and 0.901 respectively, which were higher than those of the rest TM, hence ADAM8 got the best diagnostic effect. The best accuracy and Youden index were found in the combination of ADAM8+TPS.2.2 The correlation between the serum levels before chemotherapy and the clinical responses: In different response groups, there was no significant difference among the serum levels of ADAM8,TPS,CEA before chemotherapy(P>0.15 respectively).2.3 The changes of tumor markers before and after GP regimen chemotherapy: After chemotherapy,the means of decline percentage of ADAM8,TPS in group OR(CR+PR) were 62%,56% respectively.The mean decline percentages of ADAM8,TPS in group OR were significantly higher than those in group NR(P<0.0001,P=0.0024 respectively).But there was no significant difference of the mean decline percentage of CEA between in the two groups(P=0.1160). 2.4 The relationship between the marker response criterion and the objective response criterion:According to the ROC curve on declince percentage of tumor markers, the best cut-off points for decline rates of ADAM8,TPS,CEA as the evaluation of marker response were 37%,28%,30% respectively.Once exceeding the decreasing percentage, the marker response can be concluded.And the consistency rates between the marker response criterion and the objective response criterion were 83.1%,72.9%,64.4%, among which there was no significant difference(P=0.00716).Conclusion:1.The five tumor markers indicated different assited diagnostic value, the serum levels and positive rates demonstrated the increasing tendency with the clinical stage increasing, which were significantly higher in advanced lung cancer.For early diagnosis of lung cancer,ADAM8 indicated certain value.2. In single detection, the sensitivity and specificity of ADAM8 were superior than those of other markers,and showed better diagnostic effect.3. Combined detecion can improve the sensitivity while the specificity decreased to some exent.And the combination of ADAM8+TPS was the best considering both sensitivity and specificity.4. The changes of tumor markers before and after chemotherapy can partly reflect the objective theraputic effect. ADAM8,TPS can reflect the theraputic effect better than CEA.Detection of those two markers during chemotherapy was useful to predict the theraputic effect.