血清CA125水平对非小细胞肺癌术后预后的评估

Evaluation of serum CA125 to the postoperation prognosis of non-small cell lung cancer

目的评价血清糖类抗原(CA125)水平与非小细胞肺癌(NSCLC)预后的关系。方法对56例NSCLC病人(TNM分期Ⅰ、Ⅱ、ⅢA期)于术前及术后随访时检测血清CA125水平。结果术前CA125水平高于正常值的23例患者中术后14例(60.9%)复发,术前CA125水平正常的33例中术后9例(27.3%)复发,前者较后者更易复发(P<0.01),3年后无病生存率前者(39.1%)低于后者(69.7%)(P<0.01)。术前血清CA125增高是术后复发危险的独立指标(风险率:3.08;95%CI:0.89～10.63),且提示肿瘤扩散的风险增加(风险率:7.00%,95%CI:2.39～20.51)。23例术后肿瘤复发及扩散者中13例(56.5%)CA125增高。术后血清CA125对肿瘤扩散者敏感性较高(66.7%),对局部复发者敏感性低(37.5%),对肿瘤复发及扩散预测的特异性为43.5%。结论CA125是NSCLC有效的预后指标,对术前评估肿瘤复发及扩散的风险尤有价值;术后随访监测CA125对诊断肿瘤复发尚无足够的特异性和敏感性。

Objective To evaluate the correlation between the serum level of CA125 and prognosis in the patients with non-small cell lung cancer（NSCLC）. Methods CA125 was examined in preeperation and pestoperation in 56 cases of NSCLC in the stage of Ⅰ、Ⅱ and ⅢA. Results Recurrence rate of NSCLC （60. 9% ,14/23 ） in the patients of CA125 915 U/nd was higher compared with that（27.3% ,9/33 ） in patients of CA125 〈 15 U/ml in preeperation（ P 〈 0. 01 ）. Survival rate without tumor after three years in 23 patients of CA125 ≥15 U/m] was lower than that in 33 patients of CA125 〈 15 U/ml （39. 1% vs 69. 7% ,P 〈0. 01 ）. The increasing of CA125 in preeperation was independent index of relapse in postoperation （ risk rate ： 3.08, 95 % CI： 0. 89 - 10. 63 ） , and indicated that the risk of tumor diffusion was increasing （ risk rate ：7. 00, 95 % CI：2. 39 - 20. 51 ）. Thirteen patients （56. 5 % ） with the increasing of CA125 were found in 23 patients of diffusion and relapse in postoperation of NSCLC. The Sensitivity of CA125 was 66. 7% in patients of tumor diffusion and 37. 5% in patients of local relapse（ P 〈 0. 01 ） ;The specificity of CA125≥15 U/m] was 4.3.5% in patients of tumor diffusion and relapse in postoperation. Conclusions The serum level of CA125 is a helpful prognosis index, which is especially valuable to evaluate the risk of tumor diffusion and relapse in preoperation, but examination of CA125 in postoperation lacks sufficient sensitivity and specificity in the diagnosis of tumor relapse.