Expression and clinical significance of serum squamous cell carcinoma antigen(SCCAg) in sinonasal inverted papilloma
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摘要: 目的 比较SCCAg在鼻腔鼻窦内翻性乳头状瘤和其他鼻腔鼻窦肿物的表达水平，探讨SCCAg在鼻腔鼻窦内翻性乳头状瘤的表达水平与临床预测的相关性。 方法 选取2020年9月至2023年2月收治单侧鼻腔鼻窦肿物患者68例，31例鼻内翻性乳头状瘤患者(实验组)，37例除内翻性乳头状瘤外的单侧鼻腔鼻窦肿物患者(对照组)，应用全自动化学发光免疫分析仪测试实验组患者在术前、术后1周检测血清SCCAg，对照组患者检测术前血清SCCAg，并收集临床资料。 结果 实验组术前血清SCCAg显著高于对照组，差异有统计学意义(P＜0.001)。实验组术前血清SCCAg显著高于术后1周(P＜0.001)，绘制受试者工作特征曲线图分析血清SCCAg用于诊断鼻内翻性乳头状瘤的效果，显示曲线下面积为0.968(P＜0.001)。当血清SCCAg>2.7 ng/mL时，敏感度和特异度分别为67.7%和94.6%。实验组中复发患者术前血清SCCAg显著高于对照组，差异有统计学意义(P＜0.05)。 结论 血清SCCAg检测可以应用于作为鼻内翻性乳头状瘤患者术前简单、经济有效的辅助诊断手段。术前术后血清SCCAg水平有显著差异，可以用来初步评估手术疗效。鼻内翻性乳头状瘤患者术后动态监测血清SCCAg水平，可用于预测复发风险，为术后提供一种简易可行的随访工具。Abstract: Objective To compare the expression levels of SCCAg in inverted papilloma of the nasal sinuses and other sinuses and sinus masses. To investigate the correlation between the expression of SCCAg in sinonasal inverted papilloma and outcome. Methods Sixty-eight patients with unilateral nasal and sinus masses admitted to the Otorhinolaryngology Center of the Affiliated Hospital of Guangdong Medical University from September 2020 to February 2023 were randomly selected, including 31 patients with inverted papilloma (experimental group) and 37 patients with unilateral nasal and sinus masses excluding inverted papilloma (control group). The application of automatic chemiluminescence immunoassay to test the serum SCCAg of the experimental group before surgery and 1 week after surgery, and the control group to measure the serum SCCAg before surgery. Clinical data were also collected. Results There was no significant difference between the experimental group and the control group in gender and preoperative peripheral blood inflammatory indicators. However, there was significant difference in age and preoperative serum SCCAg level(P < 0.001). The serum SCCAg levels of the experimental group before and 1 week after surgery were significantly different(P < 0.001). The positive predictive value, negative predictive value, sensitivity and specificity of serum SCCAg in the diagnosis of varus papilloma were 92.6%, 85.4%, 77.4%, 94.6% and 0.72, respectively. The effect of serum SCCAg in the diagnosis of varus papilloma was analyzed by drawing the subject's working characteristic curve, and the area under the curve was 0.968(P < 0.001). When serum SCCAg greater than 2.7 ng/mL, the sensitivity and specificity were 67.7% and 94.6%, respectively. There was statistical significance in serum SCCAg levels between patients with and without recurrence(P < 0.05). Conclusion The level of SCCAg in unilateral nasal and sinuses tumors, excluding squamous cell carcinoma, was significantly increased in inverted papilloma. The detection of serum SCCAg can be used as a simple and cost-effective auxiliary diagnostic tool for patients with nasal inverted papilloma before operation. Significant differences in preoperative and postoperative levels can be used for preliminary evaluation of surgical efficacy. Monitoring the serum SCCAg level in patients with inverted papilloma after surgery can predict recurrence and provide a simple and feasible method for postoperative follow-up.
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表 1 2组患者各临床特征比较
指标 实验组 对照组 χ2/t/U P 年龄/岁 60.29±11.91 42.97±15.72 5.162 ＜0.001 性别/例(%) 1.320 0.251 男 21(67.7) 20(64.1) 女 10(32.3) 17(45.9) 术前SCCAg水平/例(%) >2.7 ng/mL 25(80.6) 2(5.4) 36.805 ＜0.001 SCCAg值中位数 4.63(2.93，6.33) 1.17(0.72，1.39) 36.500 ＜0.001 
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表 2 2组患者外周血炎症指标比较
M(P25，P75) 外周血炎症指标 实验组 对照组 U P 白细胞计数 6.08(5.53，7.45) 6.29(5.48，7.76) 535.000 0.635 中性粒细胞计数 3.19(2.67，4.27) 3.38(2.52，4.10) 557.500 0.844 淋巴细胞计数 2.04(1.57，2.44) 2.18(1.75，2.78) 481.000 0.255 单核细胞计数 0.57(0.47，0.67) 0.49(0.41，0.67) 482.500 0.262 嗜酸性粒细胞计数 0.21(0.13，0.28) 0.17(0.10，0.24) 507.500 0.416 嗜碱性粒细胞计数 0.04(0.02，0.28) 0.03(0.02，0.05) 437.500 0.089 血小板计数 198.00(184.00，242.00) 235.00(190.00，282.50) 451.000 0.130 红细胞计数 4.45(4.21，4.95) 4.60(4.21，5.01) 521.000 0.518 NLR比值 1.70(1.40，2.11) 1.59(1.11，2.04) 497.000 0.346 PLR比值 104.32(83.04，125.22) 110.71(84.06，138.62) 537.500 0.653
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表 3 实验组临床特征与SCCAg水平的关系
例 临床特征 例数 SCCAg升高 SCCAg正常 P 性别 男 21 17 4 1.000 女 10 8 2 年龄 ≥60岁 14 12 2 0.664 ＜60岁 17 13 4 Krouse分期 T2 6 5 1 0.805 T3 21 16 5 T4 4 4 0 是否复发 是 15 13 2 0.654 否 16 12 4 吸烟史 有 8 5 3 0.083 无 23 20 3 病理特点 单纯型 20 16 4 1.000 生长活跃或有异型性 11 9 2
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