肿瘤标志物对进展期胃癌新辅助化疗敏感性预测价值探讨

Value of CEA,CA724,CA199 and CA242 in predicting the sensitivity of neoadjuvant chemotherapy for patients with advanced gastric cancer

目的探讨肿瘤标志物癌胚抗原(CEA)、胃癌抗原(CA724)、胰腺肠癌相关抗原(CA199)、糖类抗原(CA242)对进展期胃癌患者新辅助化疗敏感性的预测价值。方法选择2018-03-01-2020-12-01林州市肿瘤医院收治的70例接受新辅助化疗的进展期胃癌患者为研究对象。对比患者新辅助化疗前后血清中CEA、CA724、CA199、CA242含量;根据化疗疗效分为完全缓解(CR)+部分缓解(PR)组、病情稳定(SD)组、病情进展(PD)组,分析各组患者化疗前后CEA、CA724、CA199、CA242水平变化;通过受试者工作特征曲线(ROC)分析CEA、CA724、CA199、CA242预测患者对新辅助化疗的敏感性。结果新辅助化疗前CEA水平为(55.86±4.15)ng/mL,化疗后为(34.12±2.03)ng/mL,t=3.587,P=0.001;CA724化疗前为(52.63±6.24)U/mL,化疗后为(10.25±2.17)U/mL,t=5.884,P<0.001;CA199化疗前为(172.36±10.25)U/mL,化疗后为(92.53±5.14)U/mL,t=5.303,P<0.001;CA242化疗前为(37.02±2.11)U/mL,化疗后为(20.06±1.75)U/mL,t=3.007,P=0.002。化疗后CR+PR患者胃癌组织标本中CEA、CA199免疫组化染色强度均明显下降,与血清学指标变化趋势一致。CR+PR患者化疗后血清中CEA水平为(22.15±1.14)ng/mL,低于化疗前的(40.16±3.82)ng/mL,t=4.633,P<0.001;CA724水平为(10.41±1.03)U/mL,低于化疗前的(38.92±4.12)U/mL,t=5.033,P<0.001;CA199水平为(80.03±12.84)U/mL,低于化疗前的(142.03±11.41)U/mL,t=4.967,P<0.001;CA242水平为(14.03±1.60)U/mL,低于化疗前的(27.12±1.56)U/mL,t=2.935,P=0.002。SD患者化疗后变化不显著。PD患者化疗后CEA水平为(79.52±7.11)ng/mL,高于化疗前的(69.14±6.32)ng/mL,t=2.847,P=0.021;CA724水平为(74.13±6.81)U/mL,高于化疗前的(60.35±5.42)U/mL,t=2.631,P=0.029;CA199水平为(200.01±7.14)U/mL,高于化疗前的(180.32±6.92)U/mL,t=2.554,P=0.032;CA242水平为(52.96±4.13)U/mL,高于化疗前的(42.35±3.04)U/mL,t=2.714,P=0.021。CEA、CA724、CA199的曲线下面积(AUC)分别为0.691、0.874和0.792(均P<0.001),CA242的AUC为0.563(P=0.084),CA724的预测效能最高,其次为CA199和CEA。结论CEA、CA724、CA199水平可在一定程度上预测进展期胃癌患者对新辅助化疗的敏感性。

Objective To investigate the predictive value of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen 724(CA724),carbohydrate antigen 199(CA199),carbohydrate antigen 242(CA242)for neoadjuvant chemotherapy sensitivity in patients with advanced gastric cancer.Methods A retrospective study was conducted on 70 patients with advanced gastric cancer who received neoadjuvant chemotherapy in Linzhou Cancer Hospital from March 1 th,2018 to December 1 th,2020.The levels of CEA,CA724,CA199 and CA242 in serum before and after neoadjuvant chemotherapy were compared.Then,the patients were divided into complete response(CR)+partial response(PR)group,stable disease(SD)group and progressive disease(PD)group according to the efficacy of chemotherapy,and the levels of CEA,CA724,CA199 and CA242 in each group were analyzed before and after chemotherapy.Finally,the predictive abilities of CEA,CA724,CA199 and CA242 for neoadjuvant chemotherapy sensitivity were explored by receiver operating characteristic curve(ROC)analysis.Results Compared with the results before neoadjuvant chemotherapy,the levels of serum CEA was(34.12±2.03 vs 55.86±4.15,t=3.587,P=0.001)ng/ml,CA724(10.25±2.17 vs 52.63±6.24,t=5.884,P<0.001)U/ml,CA199(92.53±5.14 vs 172.36±10.25,t=5.303,P<0.001)U/ml,and CA242(20.06±1.75 vs 37.02±2.11,t=3.007,P=0.002)U/ml were significantly decreased,and the immunohistochemical staining intensities of CEA and CA199 in gastric cancer tissue samples were significantly decreased after chemotherapy,with statistically significant differences.In CR+PR group,the levels of CEA(22.15±1.14 vs 40.16±3.82,t=4.633,P<0.001)ng/ml,CA724(10.41±1.03 vs 38.92±4.12,t=5.033,P=0.001)U/ml,CA199(80.03±12.84 vs 142.03±11.41,t=5.303,P<0.001)U/ml and CA242(14.03±1.60 vs 27.12±1.56,t=2.935,P=0.002)U/ml were significantly decreased in serum after chemotherapy.SD group had no significant change after chemotherapy.In PD group,the level of CEA(79.52±7.11 vs 69.14±6.32,t=2.847,P=0.021)ng/ml,CA724(74.13±6.81 vs 60.35±5.42,t=2.631,P=0.029)U/ml,CA199(200.01±7.14 vs 180.32±6.92,t=2.554,P=0.032)U/ml,CA242(52.96±4.13 vs 42.35±3.04,t=2.714,P=0.021)U/ml were significantly increased.The corresponding AUC of CEA,CA724 and CA199 were 0.691,0.874 and 0.792(P<0.001),the corresponding area under curve(AUC)of CA242 was 0.563(P=0.084),CA724 had the highest predictive efficiency,followed by CA199 and CEA.Conclusion CEA,CA724 and CA199 levels can predict the sensitivity of neoadjuvant chemotherapy in patients with advanced gastric cancer.