肿瘤标志物在结直肠癌诊断和监测中的价值

Value of Tumor Markers in Diagnosis and Monitoring of Colorectal Cancer and Strategies for Further Improvement

目的:分析肿瘤蛋白芯片C12在结直肠癌(CRC)诊断中的价值。方法:分析总结130例CRC初治病人12种肿瘤标志物的检测结果,找出与CRC相关性最强的肿瘤标志物,计算各标志物组合方式对提高诊断率的贡献。结果:C12对本组CRC病人的总体诊断率是42.31%,Ⅰ、Ⅱ、Ⅲ、Ⅳ期病人的诊断率分别是13.64%,39.47%,38.24%和68.75%,除Ⅰ期与Ⅳ期相比差异有显著性外(P<0.001),其它各期两两相比差异均无统计学意义;CEA的阳性率最高,达35.38%,与之相比,阳性率最高的5种标志物的任何组合方式(2,3,4,5种标志物组合)均不能提高诊断率,但4项指标联合检测CEA+Fr-PSA+CA125+CA242或CEA+CA199+CA125+Fr-PSA足以替代12项指标联合检测。结论:C12对诊断中晚期CRC有一定价值,但对早期CRC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CRC肿瘤标志物临床应用价值的必由之路。

Objective. To evaluate the diagnostic value of tumor markers biochip diagnostic system C12 in the diagnosis of colorectal cancer （CRC）. Methods： The sera of 130 pathology-confirmed CRC patients were detected for 12 tumor markers including carcinoembryonic antigen （CEA）, alphafetoprotein （AFP）, carbohydrate antigen 19-9 （CA19-9）, carbohydrate antigen 242 （CA242）, cancer antigen 15-3 （CA15-3）, cancer antigen 125 （CA125）, prostate specific antigen （PSA）, free-PSA, neuron-specific enolase （NSE）, human chorionic gonagotropin-beta （β-HCG）, human growth hormone （HGH）, and ferritin （Fe）, using the Cl2 diagnostic biochip system. The most relevant tumor markers and the contribution of various combinations of tumor markers to the improvement of diagnosis were determined. Results： The overall diagnostic rate of Cl2 biochip system in the 130 patients was 42.31%, and 13.64%, 39.47%, 38.24% and 68.75%, respectively, for stages Ⅰ , Ⅱ , Ⅲ and Ⅳ patients. Other than the statistically significant differences in the diagnostic rates between stage Ⅰ （13.64%） and stage Ⅳ （68. 75%） （P〈0. 001）, no significant differences in diagnostic rates among all the other stages were found. Among all the 12 markers, CEA had the highest positive rate up to 35.38%, against which, any form of combinations of five most relevant tumor markers （2, 3, 4 or 5 markers combined） could not significantly improve the diagnostic rate. Conclusion： The C12 biochip diagnosis system has some value in the diagnosis of advanced CRC, but the sensitivity for early CRC is not satisfactory. Searching for new tumor markers, enhancing detection sensitivity and improving detection and differentiating methods are keys to upgrading the clinical value of tumor markers in the diagnosis of CRC.