摘要
目的探讨甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)在胃癌腹膜转移诊断及预后评估中的应用价值。方法选取2020年1月—2021年1月在首都医科大学附属北京世纪坛医院行手术治疗的102例胃癌患者作为研究对象,根据术中评估结果,将26例发生腹膜转移患者纳入转移组,76例未发生腹膜转移患者纳入无转移组。比较2组患者一般临床资料及术前血清AFP、CEA、CA125、CA19-9水平,绘制受试者工作特征曲线(ROC),分析术前AFP、CEA、CA125、CA19-9单项检测及联合检测对胃癌患者腹膜转移的诊断效能,获取最佳截断值、ROC曲线下面积(AUC)、敏感度、特异度等数据,采用Cox逐步回归分析影响胃癌腹膜转移患者预后的危险因素。结果2组患者性别构成、年龄、肿瘤位置、肿瘤组织学分级比较,差异均无统计学意义(P>0.05);转移组患者的TNM分期等级高于无转移组,差异有统计学意义(P<0.05)。转移组患者术前血清AFP、CEA、CA125、CA19-9水平均高于无转移组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,术前血清AFP、CEA、CA125、CA19-9单项检测及各指标联合检测诊断胃癌患者腹膜转移的敏感度和特异度分别为88.50%和85.50%、92.30%和84.20%、88.50%和81.60%、84.60%和82.90%以及96.20%和84.20%;术前血清AFP、CEA、CA125、CA19-9单项检测及各指标联合检测诊断胃癌患者腹膜转移的AUC值分别为0.866、0.893、0.848、0.843、0.969。Cox逐步回归分析结果显示,术前血清AFP、CEA、CA125及CA19-9水平过高均是影响胃检测癌腹膜转移患者总生存期的独立危险因素(P<0.05)。结论胃癌患者术前血清AFP、CEA、CA125、CA19-9水平与腹膜转移密切相关,联合检测对于胃癌腹膜转移具有较高的诊断价值;术前血清AFP、CEA、CA125、CA19-9水平过高是影响胃癌腹膜转移患者总生存期的独立危险因素,临床可对这些指标进行监测,辅助病情评估及预后预测。
Objective To explore the application of alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),and carbohydrate antigen 19-9(CA19-9)in the diagnosis and prognosis evaluation of peritoneal metastasis in gastric cancer.Methods A total of 102 gastric cancer patients who underwent surgical treatment at Beijing Shijitan Hospital,Capital Medical University from January 2020 to January 2021 were selected as the research participants.According to intraoperative evaluation results,26 patients with peritoneal metastasis were included in the metastasis group,and 76 patients without peritoneal metastasis were included in the non-metastasis group.The general clinical data and preoperative serum levels of AFP,CEA,CA125,and CA19-9 were compared between the two groups.Receiver operating characteristic(ROC)curves were plotted to analyze the diagnostic efficacy of preoperative AFP,CEA,CA125,and CA19-9 single-item detection and combined detection for peritoneal metastasis in gastric cancer,and to obtain the optimal cutoff value,area under the curve(AUC),sensitivity,specificity,and other data.Cox stepwise regression analysis was adopted to analyze the risk factors for the prognosis of gastric cancer patients with peritoneal metastasis.Results No statistically significant differences were observed in gender composition,age,tumor location,and tumor histological grade between the two groups(P>0.05).The TNM staging grade of the metastasis group was significantly higher than that of the non-metastasis group(P<0.05).The preoperative serum levels of AFP,CEA,CA125,and CA19-9 in the metastasis group were significantly higher than those in the non-metastasis group(P<0.05).The ROC curve analysis results showed that the sensitivity and specificity of preoperative AFP,CEA,CA125,and CA19-9 single-item detection and combined detection for peritoneal metastasis in gastric cancer were 88.50%and 85.50%,92.30%and 84.20%,88.50%and 81.60%,84.60%and 82.90%,and 96.20%and 84.20%,respectively.The AUC values of preoperative AFP,CEA,CA125,CA19-9 single-item detection and combined detection for peritoneal metastasis in gastric cancer were 0.866,0.893,0.848,0.843,and 0.969,respectively.The results of Cox stepwise regression analysis indicated that elevated preoperative serum levels of AFP,CEA,CA125,and CA19-9 were independent risk factors for the overall survival of gastric cancer patients with peritoneal metastasis(P<0.05).Conclusion Preoperative serum levels of AFP,CEA,CA125,and CA19-9 are closely correlated with peritoneal metastasis in gastric cancer,and combined detection is valuable in its diagnosis.Elevated preoperative serum levels of AFP,CEA,CA125,and CA19-9 are independent risk factors for the overall survival of gastric cancer patients with peritoneal metastasis,and these indicators can be monitored clinically to assist in disease assessment and prognosis prediction.
作者
董红旭
张彦斌
杨帆
李阳
闫国军
Dong Hongxu;Zhang Yanbin;Yang Fan;Li Yang;Yan Guojun(Department of Peritoneal Tumor Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)
出处
《保健医学研究与实践》
2023年第12期70-75,共6页
Health Medicine Research and Practice
基金
北京市优秀人才培养资助集体项目(2017400003235J007)。
关键词
胃癌
腹膜转移
甲胎蛋白
癌胚抗原
糖类抗原125
糖类抗原19-9
Gastric cancer
Peritoneal metastasis
Alpha-fetoprotein
Carcinoembryonic antigen
Carbohydrate antigen 125
Carbohydrate antigen 19-9
作者简介
第一作者:董红旭,E-mail:donghongxu@bjsjth.cn。
