CT联合血清CCNA2、FABP5对非小细胞肺癌纵隔淋巴结转移的预测价值-东南大学学报医学版

CT联合血清CCNA2、FABP5对非小细胞肺癌纵隔淋巴结转移的预测价值

单位：1. 河南大学淮河医院影像科, 河南开封 475000;
2. 河南大学淮河医院呼吸与危重症医学科, 河南开封 475000

分类号：R734.2

出版年·卷·期（页码）：2025·44·第五期（788-794）

摘要：

目的:评估CT联合血清细胞周期素A2(CCNA2)、脂肪酸结合蛋白5(FABP5)对非小细胞肺癌(NSCLC)纵隔淋巴结转移的预测价值。方法:选取2021年6月至2024年8月因NSCLC于本院行根治性切除术及纵隔淋巴结清扫术的106例NSCLC患者为研究对象,根据术后病理检查结果,74例患者纳入无淋巴结转移组,32例患者纳入淋巴结转移组。采用佳能Aquilion One 640螺旋CT对患者病变大小、位置等做出诊断;酶联免疫法检测血清CCNA2、FABP5水平;ROC曲线评估血清CCNA2、FABP5对NSCLC患者纵隔淋巴结转移的预测价值;以术后病理诊断结果为金标准,四格表法分析CT及血清CCNA2、FABP5对淋巴结转移的诊断结果;Logistic回归分析NSCLC患者发生纵隔淋巴结转移的影响因素。结果:与无淋巴结转移组比较,淋巴结转移组肿瘤组织学分型为腺癌及低分化程度的患者占比增多(P<0.05),血清CCNA2、FABP5水平显著升高(P<0.05);组织学分型为腺癌,血清CCNA2、FABP5水平升高是NSCLC患者纵隔淋巴结转移的危险因素(P<0.05);血清CCNA2、FABP5预测NSCLC患者纵隔淋巴结转移的AUC分别为0.847(95%CI 0.764~0.909)、0.860(95%CI 0.780~0.920),截断值分别为2 755.09 pg·mL^-1、9.52 μg·L^-1;CT联合血清CCNA2、FABP5诊断纵隔淋巴结转移与术后病理诊断结果的一致性较高(Kappa值=0.772,P＜0.001);CT联合血清CCNA2、FABP5预测NSCLC患者纵隔淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为81.25%、94.59%、86.67%、92.11%、90.57%,三者联合预测特异度高于三者单独检测(P<0.05),阳性预测值及准确率高于血清CCNA2、FABP5单独检测(P<0.05)。结论:CT联合血清CCNA2、FABP5对NSCLC患者纵隔淋巴结转移的预测价值较高,可能作为新的检测手段在临床应用。

Objective: To evaluate the predictive value of CT combined with serum cyclin A2(CCNA2) and fatty acid binding protein 5(FABP5) for mediastinal lymph node metastasis in non-small cell lung cancer(NSCLC). Methods: From June 2021 to August 2024, 106 NSCLC patients who underwent radical resection and mediastinal lymph node dissection in our hospital were included as the study subjects. According to the postoperative pathological examination results, 74 patients were included in the non lymph node metastasis group, and 32 patients were included in the lymph node metastasis group. Canon Aquilion One 640 spiral CT was used to diagnose the size and location of the lesion. Serum CCNA2 and FABP5 levels were detected by enzyme-linked immunosorbent assay.ROC curve was used to evaluate the predictive value of serum CCNA2 and FABP5 for mediastinal lymph node metastasis in NSCLC patients.Using the postoperative pathological diagnosis as the gold standard, the diagnostic results of CT and serum CCNA2 and FABP5 for lymph node metastasis were analyzed by four-cell table method.Logistic regression was used to analyze the influencing factors of mediastinal lymph node metastasis in NSCLC patients. Results: Compared with the non lymph node metastasis group, the lymph node metastasis group had higher proportions of adenocarcinoma and low differentiation(P<0.05), and greatly higher of serum CCNA2 and FABP5 levels(P<0.05). The histological classification of adenocarcinoma, elevated levels of serum CCNA2 and FABP5 were risk factors for mediastinal lymph node metastasis in NSCLC patients(P<0.05). The AUC values of serum CCNA2 and FABP5 in predicting mediastinal lymph node metastasis in NSCLC patients were 0.847(95%CI 0.764-0.909),0.860(95%CI 0.780-0.920),and the cut-off values were 2 755.09 pg·mL^-1 and 9.52 μg·L^-1. CT combined with CCNA2 and FABP5 in the diagnosis of mediastinal lymph node metastasis was consistent with postoperative pathological diagnosis(Kappa=0.772, P＜0.001). The sensitivity, specificity, positive prediction rate, negative prediction rate and accuracy rate of CT combined with serum CCNA2 and FABP5 in predicting mediastinal lymph node metastasis in NSCLC patients were 81.25%, 94.59%, 86.67%, 92.11% and 90.57%, respectively. The prediction specificity of the three methods combined was higher than that of the three methods alone(P<0.05), and the positive prediction rate and accuracy were higher than that of serum CCNA2 and FABP5 alone(P<0.05). Conclusion: CT combined with serum CCNA2 and FABP5 has a high predictive value for mediastinal lymph node metastasis in NSCLC patients and may be used as a new detection method in clinical applications.

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