摘要
目的探讨术前血清癌胚抗原(carcino-embryonic antigen,CEA)和糖链抗原19-9(carbohydrate antigen 19-9,CA19-9)联合检测对Ⅱ~Ⅲ期结肠癌根治术患者远期预后的临床意义。方法回顾性分析2010-01/2015-01月在作者医院行结肠癌根治术治疗的325例Ⅱ~Ⅲ期结肠癌患者的临床资料,依据受试者工作特征曲线(receiver operating characteristic,ROC)确定术前血清CEA与CA19-9预测术后患者总生存时间的最佳临界值,将纳入患者分为高CEA、低CEA组和高CA19-9、低CA19-9组,比较患者的临床病理特征,分析术前血清CEA与CA19-9对患者远期预后的影响。结果 ROC曲线显示,血清CEA、CA19-9预测术后总生存时间的最佳临界值分别为21.29 ng/ml和101.45 U/ml,依此临界值将术前血清CEA和CA19-9阳性患者分为高CEA(>21.29 ng/ml)、低CEA组(<21.29 ng/ml)和高CA19-9(>101.45 U/ml)、低CA19-9组(<101.45 U/ml)。所有患者中位随访时间为57.85(3.8~71.9)个月,高CEA、低CEA组患者术后中位生存时间分别为42.21和53.61个月,高CA19-9、低CA19-9组患者的中位生存时间分别为37.63和50.19个月。Cox回归模型单因素分析显示,肿瘤大体分型、肿瘤最大径、肿瘤分期(topography lymphnode metastasis,TNM)、淋巴结转移及术后化疗对患者的生存时间均有影响(P均<0.05);多因素分析显示,患者发病年龄≥65岁(HR=1.108,95%CI:1.016~1.208)、临床TNM分期Ⅲ期(HR=3.388,95%CI:0.424~27.070)、术前高CEA(HR=5.996,95%CI:0.978~31.014)、高CA19-9(HR=3.771,95%CI:0.991~29.001)及术后远处转移(HR=7.395,95%CI:0.768~19.154)、术后未行辅助化疗(HR=5.828,95%CI:1.021~33.260)是影响患者预后的独立危险因素。结论术前血清CEA、CA19-9高水平对Ⅱ~Ⅲ期结肠癌患者根治术后远期预后有良好的预测价值,当术前血清CEA>21.29 ng/ml,血清CA19-9>101.45 U/ml时预后不良。
Objective To investigate the clinical effect of preoperative detection of serum carcino-embryonic antigen(CEA)combined carbohydrate antigen 19-9(CA19-9)on the long-term prognosis of patients with stageⅡ-Ⅲcolon cancer.Methods A total of 325 patients with stageⅡ-Ⅲcolon cancer who underwent radical resection from January 2010 to January 2015 in author’s hospital were retrospectively analyzed.The optimal threshold of serum CEA and CA19-9 for predicting the total survival time of patients after operation were determined by ROC curve.According to the threshold,the patients were divided into high CEA group,low CEA group and high CA19-9 group,low CA19-9 group.The clinicopathological characteristics in groups were compared and the influence of preoperative serum CEA and CA19-9 on the long-term prognosis of patients were analyzed.Results ROC curves showed that the optimal threshold of serum CEA and CA19-9 for predicting the total survival time were 21.29 ng/ml and 101.45 U/ml,respectively.According to these threshold,preoperative serum CEA and CA19-9 positive patients were divided into high CEA group(>21.29 ng/ml),low CEA group(<21.29 ng/ml)and high CA19-9 group(>101.45 U/ml),low CA19-9 group(<101.45 U/ml).The median follow-up time was 57.85(3.8-71.9)months,42.21 and 53.61 months for high CEA and low CEA,37.63 and 50.19 months for high CA19-9 and low CA19-9,respectively.Cox regression model showed that gross classification of tumors,maximum diameter of tumors,topography lymphnode metastasis(TNM)stage,lymph node metastasis and post-operative chemotherapy had effects on survival time of patients(all P<0.05).Multivariate analysis showed that the age of patients at diagnosis≥65 years old(HR=1.108,95%CI:1.016-1.208),clinical TNM stageⅢ(HR=3.388,95%CI:0.424-27.070),preoperative high CEA level(HR=5.996,95%CI:0.978-31.014),high CA19-9(HR=3.771,95%CI:0.991-29.001),distant metastasis(HR=7.395,95%CI:0.768-19.154)and no adjuvant chemotherapy(HR=5.828,95%CI:1.021-33.260)were independent risk factors affecting the prognosis of patients.Conclusion Preoperative high levels of serum CEA and CA19-9 have good predictive value for long-term prognosis of patients with stageⅡ-Ⅲcolon cancer after radical resection.When preoperative serum CEA>21.29 ng/ml and serum CA19-9>101.45 U/ml,the prognosis is poor.
作者
韩文峰
李兆龙
党文呈
魏丰贤
徐小东
张有成
HAN Wenfeng;LI Zhaolong;DANG Wencheng;WEI Fengxian;XU Xiaodong;ZHANG Youcheng(Department of Second General Surgery,Second Hospital of Lanzhou University,Lanzhou Gansu 730030,China)
出处
《华南国防医学杂志》
CAS
2019年第7期462-467,共6页
Military Medical Journal of South China
基金
兰州大学博士生导师科研基金(bdkyjj-04)
兰州大学第二医院萃英科技创新计划(GY2018-MS14)
关键词
结肠癌
癌胚抗原
糖链抗原19-9
预后
Colon cancer
Carcino-embryonic antigen
Carbohydrate antigen 19-9
Prognosis
作者简介
通信作者:张有成,E-mail:zhangychmd@126.com
