肿瘤标志物在胃癌诊断和监测中的价值和改进策略(附100例报告)

The Value of Tumor Markers in the Diagnosis and Monitoring of Gastric Cancer and the Strategies for Further Improvement:Analysis of 100 Cases

目的分析肿瘤标志物诊断芯片C12在胃癌诊断中的价值。方法分析100例胃癌初治病人应用C12系统的检测结果,寻找与胃癌相关性最强的肿瘤标志物,计算不同标志物组合方式对提高诊断率的贡献。结果C12诊断系统对本组胃癌病人的总体诊断率为37%;对I、II、III、IV期的诊断率分别是7.8%、29.4%、35.5%和50.0%,其中对I期和IV期的诊断率相比有显著性差异(<0.01)。CA19-9的阳性率最高(23%);阳性率较高的前5种标志物的任何组合方式(2种、3种、4种、5种标志物组合)均不能提高诊断率。结论C12系统对诊断晚期胃癌有一定价值,但用于早期胃癌的灵敏度不高。发现新的肿瘤标志物、提高检测灵敏度、改进检测甄别方法,是提高胃癌肿瘤标志物临床应用价值的必由之路。

Objective To explore the diagnostic value of tumor markers biochip diagnostic system C12 in the diagnosis of gastric cancer. Methods The sera of 100 pathology-confirmed gastric carcinoma patients were detected for 12 tumor markers including carcinoembryonic antigen （CEA）, alpha-fetoprotein （AFP）, carbohydrate antigen 19-9 （CA19-9）, carbohydrate antigen 242 （CA242）, cancer antigen 15-3 （CA 15-3）, cancer antigen 125 （CA125）, prostate specific antigen （PSA）, free-PSA, neuron-specificenolase （NSE）, human chorionic gonagotropin-beta （β-HCG）, human growth hormone （HGH）, and ferritin （Fe）, using the C 12 diagnostic biochip system. The most relevant tumor marker and the contribution of various combinations of tumor markers to the improvement of diagnosis were determined.Results The overall diagnostic rate of C 12 biochip system in our group of 100 patients was 37%, and for stages Ⅰ,Ⅱ ,Ⅲ and Ⅳ patients, it was 7.8%, 29.4%, 35.5% and 50%, respectively. The differences in diagnostic rates between stage Ⅰ （7.8%） and stage Ⅳ （50%） reached statistical significance （chi-square test,n=7.20, P〈0.01）. Among all the 12 markers, CAl9-9 had the highest positive rate up to 23%, against which any form of combinations of 5 most relevant tumor markers （2, 3, 4 or 5 markers combined） could not significantly improve the diagnostic rate.Conclusion The C 12 biochip diagnosis system has some value in the diagnosis of advanced stage gastric cancer, but the sensitivity for early stage gastric cancer is not satisfactory. Finding new tumor markers, enhancing detection sensitivity and improving detection and differentiating methods are keys to upgra- ding the clinical value of tumor markers in the diagnosis of gastric cancer.