| Background:Lung cancer is a malignant tumor with the highest incidence and mortality in the world,which seriously endangers human life and health.In the early stage of lung cancer,there are often no typical clinical symptoms,so people tend to ignore its existence and miss the best time for treatment.Most patients were in advanced stage when they were confirmed,with extremely low surgical chances and survival rates.Therefore,early diagnosis of lung cancer has become a top priority in the diagnosis and treatment of lung cancer,and is also the primary measure to effectively reduce the mortality of lung cancer.Currently,the main methods of early lung cancer screening include tumor markers,chest CT imaging,peripheral blood or small RNAs in tissue cells and detection of tumor autoantibodies.With the improvement of medical and health level and public health awareness,the number of people who take the initiative to carry out early lung cancer screening is gradually increasing.As one of the most commonly used screening methods,low-dose chest CT is widely promoted.Although low-dose chest CT screening can significantly reduce the mortality of lung cancer,it also has its limitations,such as the false-positive rate which is up to 40%.Moreover,the patient is exposed to radiation repeatedly,which affects its wide application.In addition,with the continuous progress of lung cancer,tumor associated antigens(TAAs)are generated,which can stimulate the human immune system to produce corresponding tumor autoantibodies,which are earlier than clinical symptoms,and the latter has high stability;however,its sensitivity is not high,and single detection can not meet the needs of early screening of lung cancer.Therefore,in order to further improve the clinical application value of lung cancer screening,the combination between tumor autoantibodies detection and low-dose chest CT may be the best approach for early screening of lung cancer.Objective:To investigate the clinical effect and application value of seven serum tumor autoantibodies(p53,PGP9.5,SOX2,GAGE7,GBU4-5,CAGE,MAGE-A1)combined with low-dose chest CT in the early diagnosis of lung cancer,so as to provide clinical reference for the early diagnosis of lung cancer.Methods:From June 2018 to December 2019,93 patients with pulmonary nodule were selected from the thoracic surgery department of the second hospital of Shandong University and found through low-dose chest CT and other auxiliary examinations.63 cases with lung cancer and 30 cases with benign diseases were confirmed by pathological diagnosis,and they were divided into lung cancer group and benign disease group respectively;32 healthy physical examinees who visited the hospital during the same period were set as the healthy control group,all of them underwent low-dose chest CT examination,and no pulmonary nodules were found.ELISA method was used to determine the levels of seven tumor autoantibodies in serum samples of three groups,and the expression levels and positive rates of seven tumor autoantibodies were analyzed;the sensitivity and specificity of seven tumor autoantibodies combined detection in the diagnosis of lung cancer were analyzed;the relationship between the different clinical characteristics of patients with lung cancer and the positive rates of tumor autoantibodies was analyzed;the positive rate and false positive rate of low-dose chest CT for pulmonary nodules were analyzed;the influence of different clinical characteristics of patients with lung cancer on the combined detection of seven tumor autoantibodies and low-dose chest CT was analyzed;the evaluation index and clinical diagnosis value of seven tumor autoantibodies combined with low-dose chest CT in the early diagnosis of lung cancer were studied.Data analysis:SPSS 25.0 software was used for statistical analysis of the data.The counting data(age)were normally distributed and expressed as meanąSD.The counting data were expressed by the number of cases and the positive rate,and chi-square test was used for comparison between the two groups.The level of autoantibodies was not normally distributed and was expressed as median(quartile).When P<0.05,the difference was viewed as statistical significance;when P?0.05,the difference was not regarded as statistical significance.The sensitivity,specificity,and AUC values of seven serum tumor autoantibodies individual and combined detection in the early diagnosis of lung cancer were analyzed by plotting the ROC curve.Results:1.The expression level and positive rate of seven serum tumor autoantibodies in lung cancer group were significantly higher than that in non-lung cancer group,the difference was viewed as statistical significance(P<0.05).2.There was no significant difference in the positive detection rate of seven serum tumor autoantibodies combined detection in lung cancer patients with different clinical characteristics from different groups(P>0.05).3.The sensitivity,specificity and AUC value of the seven serum tumor autoantibody combined detection in the diagnosis of patients with lung cancer were 65.1%,82.3%and 0.808 respectively,which were all higher than those of each autoantibody.4.The sensitivity and specificity of low-dose chest CT in the diagnosis of lung cancer were 81.0%and 66.7%respectively,but there was also a high false positive rate(33.3%).5.Combined with low-dose chest CT,the positive rate of the seven serum tumor autoantibodies increased to 87.3%in the lung cancer group,showing no statistical difference compared with the diagnosis of low-dose chest CT alone(P>0.05),and there was a statistical difference compared with the diagnosis of low-dose chest CT alone(P<0.05).In the benign lesion group,the positive rate of the two combined methods increased to 80.0%,and the false positive rate decreased to 20.0%.Compared with the low-dose chest CT alone,the false positive rate decreased significantly,with a statistically significant difference.6.The sensitivity(87.3%)and specificity(85.5%)of seven serum tumor autoantibodies combined with low-dose chest CT in the diagnosis of lung cancer could be further improved,and the false-positive rate(14.5%)was significantly reduced.Conclusion:Seven serum tumor autoantibodies detection combined with low-dose chest CT is superior to single detection in early diagnosis of lung cancer,which can improve the diagnosis rate of lung cancer,enable lung cancer patients to get early diagnosis and early treatment.The combined detection of the two methods can significantly improve the sensitivity and specificity in early diagnosis of lung cancer,which is worthy of clinical application. |
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