Dijagnoza metastaza u kostima kod obolelih od nesitnoćelijskog karcinoma pluća kombinovanom detekcijom CEA, CYFRA21-1 i ALP
Sažetak
Uvod/Cilj. Uprkos značajnom napretku u dijagnostici i lečenju nesitnoćelijskog karcinoma pluća (non-small cell lung cancer – NSCLC), ukupna prognoza ostaje loša, posebno kada se sa progresijom bolesti javljaju metastaze u kostima. Cilj rada bio je da se ispita dijagnostička vrednost kombinovane detekcije karcinoembrionalnog antigena (carcinoembryonic antigen – CEA), fragmenta citokeratina 19 (cytokeratin 19 fragment antigen 21-1 – CYFRA21-1) i alkalne fosfataze (alkaline phosphatase – ALP) za predikciju metastaza u kostima kod obolelih od NSCLC. Metode. U studiju je ukupno bilo uključeno 148 obolelih od NSCLC. Oni su odabrani među bolesnicima koji su bili hospitalizovani radi lečenja između aprila 2020. i marta 2022. godine. Od ukupnog broja bolesnika, njih 68 svrstano je u grupu sa metastazama, a 80 u grupu bez metastaza. Prikupljeni su uzorci krvi bolesnika da bi se izmerili nivoi CEA, CYFRA21-1 i ALP u serumu. Multivarijantna logistička regresija korišćena je da bi se utvrdili faktori koji doprinose nastanku metastaza u kostima. Za analizu dijagnostičke vrednosti korišćene su receiver operating characteristic (ROC) krive. Rezultati. Metastaze kostiju javile su se kod 68 (45,94%) bolesnika. Osnovni podaci bolesnika nisu pokazali značajne razlike između grupa (p > 0,05). Grupa bolesnika sa metastazama imala je značajno povišene nivoe CEA, CYFRA21-1 i ALP u serumu, u poređenju sa grupom bez metastaza (p < 0,05). Povišeni nivoi CEA [odds ratio (OR): 1,062, 95% confidence interval (CI): 1,031–1,094], CYFRA21-1 (OR: 1,155, 95% CI: 1,061–1,258) i ALP (OR: 1,027, 95% CI: 1,008–1,047) u serumu bili su faktori rizika za metastaze kostiju (OR > 1, p < 0,05). Površine ispod ROC kriva za CEA, CYFRA21-1, ALP i njihove kombinacije bile su veće od 0,600, što ukazuje na visoke dijagnostičke vrednosti. Zaključak. Nivoi CEA, CYFRA21-1 i ALP u serumu mogu predvideti metastaze kostiju kod obolelih od NSCLC, pri čemu je prediktivna vrednost njihove kombinacije veća od bilo kog pojedinačnog markera.
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