结直肠癌患者术前血清学指标及肿瘤标志物与术后肿瘤特征的大样本研究

The relationship between preoperative routine blood tests and postoperativetumor characteristics in patients with colorectal cancer

目的利用大样本资料系统性评估结直肠癌(CRC)患者术前常规血液学检查结果与肿瘤大小、转移情况、分期等的关系。方法收集2009年12月—2017年9月蚌埠医学院第一附属医院932例手术CRC患者的临床资料,分析患者术前1周临床血液学检查数据,包括炎症指数、白蛋白、癌胚抗原(CEA)、糖类抗原199(CA199)等指标与肿瘤大小、淋巴结转移、远处转移、TNM分期、组织病理学分级的关系。结果932例患者中男性538例,直肠癌593例,年龄24~89岁,平均年龄(61.89±11.98)岁,中位年龄63岁。T3和T4期患者相较于早期T0-2期患者,术前外周血CEA、CA199和中性粒细胞升高(P<0.05),淋巴细胞和血红蛋白降低(P<0.05)。相较于未发生淋巴结转移的患者,有淋巴结转移的患者术前外周血CEA和CA199升高(P<0.05)。发生远处转移的患者较未转移患者白细胞、中性粒细胞和CEA升高(P<0.05)。ROC曲线分析表明术前炎症指数、CEA、CA199拟合曲线预测T3和T4期的敏感性为86.5%,特异性为49.1%;术前CEA、CA199拟合曲线预测淋巴结转移的敏感性为67.4%,特异性为56.7%;术前CEA、CA199拟合曲线预测远处转移的敏感性为88.9%,特异性为24.8%。结论CRC患者术前外周血常规、CEA、CA199与术后肿瘤大小、淋巴结和远处转移、TNM分期等影响患者远期预后的因素存在一定相关性,但其预测价值以及与术后肿瘤特征的相关性有限。

Objective To systematically evaluate the relationship between preoperative routine blood test and tumor size,metastasis and stage in colorectal cancer(CRC)patients based on large samples.Methods A total of 932 patients undergoing CRC surgery in the First Affiliated Hospital of Bengbu Medical College from December 2009 to September 2017 were enrolled and their clinical data were collected.The relationships between their routine blood test data one week before surgery,including inflammatory index,albumin,carcinoembryonic antigen(CEA)and CA199,and tumor size,lymph node metastasis,distant metastasis,TNM stage,and histopathological grade were analyzed.Results There were 538 men in the current study and 593 rectal cancer cases.The age ranged from 24 to 89 years,with an average age of(61.89±11.98)years and a median age of 63 years.Compared with early T0-2 stage patients,T3 and T4 stage patients presented increases in peripheral blood CEA,CA199 and neutrophil counts before surgery(P<0.05),as well as decreases in lymphocyte count and hemoglobin count(P<0.05).Compared with those without metastasis,patients with lymph node metastasis showed increases in peripheral blood CEA and CA199 before surgery(P<0.05).Patients with distant metastasis presented higher white blood cell counts,neutrophil counts and CEA than those without metastasis(P<0.05).Furthermore,a ROC curve was plotted using inflammatory indexes,CEA,and CA199 for T3 and T4,with a sensitivity of 86.5%and a specificity of 49.1%.A ROC curve was plotted using preoperative CEA and CA199 for lymph node metastasis,with a sensitivity of 67.4%and a specificity of 56.7%.A ROC curve was plotted using preoperative CEA and CA199 for distant metastasis,with a sensitivity of 88.9%and a specificity of 24.8%.Conclusions Preoperative routine blood test,CEA,CA199 are related with some factors influencing long-term prognosis,such as tumor size,lymph node positive,and distant metastasis,TNM stage.But their predictive value and relationship with postoperative tumor characteristics are limited.