CYFRA 21-1, Carcinoembryonic Antigen 및 이들 조합의 폐암 진단 성능 평가 = Performances of CYFRA 21-1, Carcinoembryonic Antigen and Their Combination for Lung Cancer Diagnosis

국문 초록 (Abstract)

배경: 본 연구에서는 폐암 진단을 위한 종양 표지자인 cytokeratin 19 fragment (CYFRA 21-1)과 carcinoembryonic antigen (CEA)의 진단 성능을 비교하고 최적의 판정기준치를 설정하고자 하였다. 방법: 폐암 진단을 위하여CYFRA 21-1과 CEA 검사를 동시에 시행 한 1,176예을 대상으로 연구를 진행하였으며, 이들을 종양표지자 검사가 의뢰된 이후의 진단명에 따라 폐암 93예, 전체 대조군 1,083 예로 구분하였고, 전체 대조군 중에서 환자군과 유사한 연령대의 대조군 146예를 선정하였다. 다변량 분석을 이용하여 각 종양표지 자의 농도와 폐암 진단과의 연관성을 확인하였으며 receiver operating characteristic-areas under the curve (ROC-AUC) 분석을 이 용하여 대상자 별 종양표지자 조합의 진단 성능을 평가하였다. 결과: 회귀분석 결과 환자의 나이와 CYFRA 21-1 및 CEA의 농도는 폐암 진단과 유의한 연관성이 있었으며 폐암의 조직학적 소견에 따라 각각의 표지자의 진단 성능에 차이가 있었다. 전체 대조군 및 환자군과 연령대가 유사한 대조군 모두에서 비소세포폐암의 진단 의 경우 두 표지자 조합의 AUC가 각각 0.8661과 0.7559로 가장 높 았으나, 편평상피세포암의 경우 같은 대조군에 대하여 CYFRA 21-1 단독 검사의 AUC가 각각 0.9245와 0.8428로 가장 높았다. 본 연구에서 설정한 판정기준치를 적용하였을 때, 비소세포폐암, 선 암 및 편평상피세포암의 진단에서 CYFRA 21-1과 CEA의 민감도와 특이도가 향상되었다. 결론: CYFRA 21-1 및 CEA는 비소세포폐암 진단 시 수용할 만한 특이도와 음성예측도를 보여 폐암 진단을 배제하는 목적으로 활 용 시 유용할 것으로 생각되며, 폐암의 조직학적 유형에 따라 두 종양표지자를 단독으로 또는 적절히 조합하여 활용하는 것이 폐 암 진단에 도움이 될 것으로 보인다.

다국어 초록 (Multilingual Abstract)

Background: The aim of this study was to compare the efficiency of cytokeratin 19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA) for the diagnosis of lung cancer and to establish the optimal cut-off values. Methods: We retrospectively reviewed the medical records of 1,176 subjects with CYFRA 21-2 and CEA data; they were classified into 93 lung cancer cases and 1,083 total controls, including 146 age-matched controls. Multivariate analysis was used to determine the relationship between the concentration of each tumor marker and lung cancer diagnosis. The diagnostic efficiencies of tumor markers were evaluated using receiver operating characteristic curve analysis and areas under the curve (AUCs) were calculated. The optimal cut-offs for CYFRA 21-1 and CEA were also estimated. Results: Age, CYFRA 21-1, and CEA concentrations were independently associated with lung cancer diagnosis. Diagnostic efficiency of each tumor marker and its’ combination was different according to the histological types of lung cancer. For non-small cell lung cancer, the AUCs for the two-marker combination were the highest: 0.8661 and 0.7559 for total and age-matched controls, respectively. For squamous cell carcinoma, the AUCs for CYFRA 21-1 were the highest: 0.9245 and 0.8428 for total and age-matched controls, respectively. The sensitivity and specificity of CYFRA 21-1 and CEA for lung cancer diagnosis were improved when the cutoffs determined based on this study were applied. Conclusions: CYFRA 21-1 and CEA could be useful markers for diagnosing lung cancer and single or combination of markers may be useful according to different histological types of lung cancer.

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