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目的探讨食管鳞癌的螺旋CT征象与血清中Cyfra21-1表达的相关性。方法选择76例术前未进行化疗和放疗的食管鳞癌患者,全部患者术前均行螺旋CT增强扫描,分析螺旋CT对食管鳞癌淋巴结转移诊断的灵敏度、特异度、准确率;采用电化学发光法检测食管鳞癌患者术前血清中Cyfra21-1的表达。对食管鳞癌患者术前CT征象与Cyfra21-1检测结果进行比较,分析其相关性。结果 76例食管鳞癌患者中,螺旋CT扫描诊断与手术病理结果对照,对淋巴结转移诊断的灵敏度为67.5%,特异度为83.3%,准确率为75.0%,Kappa值为0.512。螺旋CT表现为肿瘤长度>5cm者Cyfra21-1表达的阳性率高于肿瘤长度≤5cm者(P<0.05);CT表现为食管管壁增厚>1cm者Cyfra21-1表达的阳性率高于管壁增厚≤1cm者(P<0.01);CT表现有淋巴结转移组Cy-fra21-1表达的阳性率高于无淋巴结转移者(P<0.05)。肿瘤位于食管上、中、下段者Cyfra21-1表达的阳性率比较无明显差异(P>0.05)。经病理证实有淋巴结转移者食管癌患者血清中Cyfra21-1阳性表达率高于无淋巴结转移者,差异有统计学意义(P<0.05),Cyfra21-1的阳性表达与食管癌淋巴结转移存在相关性(P<0.05)。结论 Cyfra21-1阳性表达与食管癌CT征象上癌肿长度、管壁增厚程度和淋巴结转移相关,螺旋CT扫描对术前诊断食管癌淋巴结转移有一定的帮助。
Objective To investigate the correlation between spiral CT signs and serum Cyfra21-1 expression in esophageal squamous cell carcinoma. Methods 76 patients with esophageal squamous cell carcinoma who had not undergone chemotherapy and radiotherapy before operation were enrolled in this study. All patients underwent preoperative spiral CT enhancement scanning to analyze the sensitivity, specificity and accuracy of spiral CT in diagnosis of lymph node metastasis of esophageal squamous cell carcinoma. Luminescence assay for detecting the expression of Cyfra21-1 in preoperative serum of patients with esophageal squamous cell carcinoma. Preoperative CT findings of esophageal squamous cell carcinoma in patients with Cyfra21-1 test results were compared to analyze the correlation. Results Among 76 esophageal squamous cell carcinoma patients, the diagnostic value of spiral CT scan was 67.5%, the specificity was 83.3%, the accuracy was 75.0% and the Kappa value was 0.512. The positive rate of Cyfra21-1 expression in CT> 5cm was higher than that in tumor ≤5cm (P <0.05). The positive rate of Cyfra21-1 in CT scan was higher than that in tube (P <0.01). The positive rate of Cy-fra21-1 expression in lymph node metastasis group with lymph node metastasis was higher than that without lymph node metastasis (P <0.05). There was no significant difference in the positive rate of Cyfra21-1 expression in the upper, middle and lower esophagus (P> 0.05). The positive rate of Cyfra21-1 in the serum of esophageal cancer patients with pathologically confirmed lymph node metastasis was significantly higher than those without lymph node metastasis (P <0.05). There was a correlation between the positive expression of Cyfra21-1 and lymph node metastasis (P <0.05). Conclusion The positive expression of Cyfra21-1 is associated with the length of cancer, the degree of wall thickening and the lymph node metastasis in CT signs of esophageal cancer. Spiral CT scan is helpful for the preoperative diagnosis of lymph node metastasis of esophageal cancer.