多层螺旋CT和血清肿瘤标志物对胃癌术前评估的价值

Clinical significance of multi-slice spiral CT and serum tumor markers in the preoperative assessment of gastric carcinoma

目的:探讨多层螺旋CT(multi-slice spiral CT,MSCT)和血清肿瘤标志物对胃癌术前评估的价值.方法:对220例活检证实的胃癌患者术前行MSCT检查,并将其结果与手术病理结果对照.同时,术前检测该220例患者血清中肿瘤标志物CA125,CA19-9,CA72-4,CEA和AFP的水平,并分析其与胃癌临床病理特征的关系.结果:MSCT对胃癌T和N分期的判断准确率分别为78.64%和74.09%,对胃癌远处转移判断的敏感度、特异度和准确率分别为65.63%,99.47%和94.55%,对胃癌肝脏、腹膜和远处淋巴结转移判断的敏感度及TNM分期和可切除性的判断准确率分别为83.33%,33.33%和78.57%,58.54%和91.36%.采用ROC分析评价时,血清CA125对胃癌浸润深度、远处转移、腹膜转移和TNM分期判断的准确率均较高,血清CA19-9对胃癌可切除性判断的准确率较高,血清CA72-4对胃癌腹膜转移和远处淋巴结转移判断的准确率均较高.当10μg/L和11μg/L分别作为血清CEA和AFP的临界值时,血清CEA水平与患者性别、胃癌最大径、组织学类型、浸润深度、远处转移、远处淋巴结转移和TNM分期密切相关,但血清AFP水平与患者年龄、性别、肿瘤部位、肿瘤最大径、组织学类型、浸润深度、转移、TNM分期和可切除性均无关.结论:多层螺旋CT和血清肿瘤标志物CA125,CA19-9,CA72-4和CEA对胃癌术前评估具有较大的临床应用价值,但血清AFP对胃癌术前评估的价值有限.

AIM： To investigate the value of multi-slice spiral CT （MSCT） and serum tumor markers in the preoperative assessment of gastric carcinoma. METHODS： MSCT was performed preoperatively in 220 patients with gastric carcinoma confirmed by biopsy, and the results were compared with surgical pathological findings. In addition, preoperative serum tumor marker levels of CA125, CA19-9, CA72-4, CEA and AFP were measured, and the correlation between tumor marker levels and clinicopathological parameters of gastric carcinoma was analyzed.RESULTS： The overall accuracy of MSCT inpreoperative T staging of gastric carcinoma was 78.64%. The overall accuracy of MSCT in preoperative N staging of gastric carcinoma was 74.09%. The diagnostic sensitivity, specificity and accuracy of MSCT for determining distant metastases of gastric carcinoma were 65.63%, 99.47% and 94.55%, respectively. The diagnostic sensitivity of MSCT was 83.33% for hepatic metastasis, 33.33% for peritoneal metastasis, and 78.57% for distant lymph node metastasis. The overall accuracy of MSCT for determination of TNM stage of gastric carcinoma was 58.54%. The accuracy of MSCT in evaluating resectability of gastric carcinoma was 91.36%. Receiver operating characteristics analysis showed that the accuracy of serum CA125 for determination of depth of invasion, distant metastasis, peritoneal metastasis, and TNM stage of gastric carcinoma was relatively high. The accuracy of serum CA19-9 for determination of surgical resectability was relatively high. In addition, the accuracy of serum CA72-4 for determination of peritoneal and distant lymph node metastasis of gastric carcinoma was relatively high. The recommended cut-off value of serum CEA and AFP was 10 μg/L and 11 μg/L, respectively. The serum CEA level was closely related to gender, maximum diameter of gastric carcinoma, histological type, depth of invasion, distant metastasis, distant lymph node metastasis, and TNM stage. How- ever, there was no significant correlation between serum AFP level and age, gender, tumor location, maximum tumor diameter, histological type, depth of invasion, lymph node, distant, hepatic, peritoneal and distant lymph node metastasis, TNM stage; and surgical resectability. CONCLUSION： The clinical value of MSCT and serum CA125, CA19-9, CA72-4 and CEA in the preoperative assessment of gastric carcinoma is relatively high. However, serum AFP has limited value in the preoperative assessment of gastric carcinoma.