三维适形放疗联合热疗治疗胰腺癌患者外周血中肿瘤标志物变化的初步研究

Preliminary study of tumor markers changes in the peripheral serum of pancreatic cancer patients treated by three-dimensional conformal radiotherapy combined with hyperthermia

目的 检测三维适形放疗联合内生场热疗治疗晚期胰腺癌患者外周血清中癌胚抗原（CEA）及糖类抗原CA19-9、CA242、CA72-4及单涎酸神经节苷脂抗原（CA50）的表达水平及临床意义.方法 60例不能手术的晚期胰腺癌患者,采用三维适形放疗联合内生场热疗进行治疗,DT 46 ～66 GY/23 ～33 F,放疗期间行肿瘤局部区域热疗,温度41 ～43℃,2次/周,持续60 min.治疗过程中每2周采用电化学发光免疫分析技术（ ECLIA）检测外周血清中CEA、CA19-9、CA242、CA72-4及CA50的表达,并与肿瘤直径、临床分期、淋巴结转移情况进行相关性分析.结果 从开始治疗至第8周,随着三维适形放射治疗联合局部热疗治疗的不断进行,CEA、CA19-9、CA50及CA242的表达水平呈逐渐下降趋势,第6周时分别为（6.22 ±2.71） μg/L、（43.44±12.93） μg/L、（23.21±7.71）μg/L、（24.26±8.92）μg/L,与第0周、第2周、第4周相比较,差异均有统计学意义（P＜0.05）.而第6周与第8周相比较,CEA、CA19-9、CA50及CA242的表达水平差异无统计学意义（P＞0.05）.CA724的表达水平无明显变化（P＞0.05）.经Spearman等级相关分析示CEA、CA19-9、CA50及CA242与胰腺癌病灶大小、临床分期、淋巴结转移呈正相关（r=0.877,0.725,0.826,P＜0.01）,而CA724与病灶大小、临床分期及淋巴结转移无相关（P＞0.05）.结论 外周血清CEA、CA19-9、CA50及CA242的表达与胰腺癌治疗疗效密切相关,其联合检测可对晚期胰腺癌的治疗、疗效观察和预后评价提供独立而客观的参考信息.

Objective To determine the peripheral serum expressions and clinical value of carcinoembryonic antigen （CEA） and carbohydrate antigen CA19-9,CA242,CA72-4 and a single sialic acid ganglioside （CA50） antigen in advanced pancreatic cancer patients treated by three-dimensional conformal radiotherapy （3D-CRT） combined with endogenous field hyperthermia.Methods 60 patients inoperable,advanced pancreatic cancer were treated by 3D-CRT combined with endogenous field hyperthermia.Radiation dose （DT） was 46 ～ 66 GY/23 ～ 33 F.Hyperthermia temperature was 41 ～ 43 ℃ 2 times/week,lasted 60 min each time.The expressions of CEA,CA19-9,CA242,CA72-4 and CA50 in peripheral serum were detected by Electrochemiluminescence immunoassay （ECLIA） every 2 weeks during treatment,and correlation were analyzed with tumor diameter,clinical stage,lymph node metastasis.Results From the 8th week,with 3D-CRT combined with endogenous field hyperthermia ongoing,CEA,CA19-9,CA50 andCA242 expression levels showed a gradual decline.CEA,CA19-9,CA50 and CA242 expression levels were （6.22 ± 2.71 ） μg/L,（43.44 ± 12.93 ） μg/L,（23.21 ± 7.71 ）g/L and （24.26 ± 8.92） μg/L in 6 weeks,respectively.The difference was statistically significant among week 6 and week 0,week2,week 4 （ P 〈0.05）,however there was no significant difference between week 6 and week 8 （ P 〉 0.05 ）.The CA724 expression did not change significantly （ P 〉 0.05 ）.There were positively correlation between CEA,CA199,CA50 and CA242 with pancreatic cancer tumor size,clinical stage and lymph node metastasis（ respectively r =0.877,0.725,0.826,all P 〈 0.01 ）,however CA72-4 had no correlations （ P 〉 0.05）.Conclusions CEA,CA19-9,CA50 and CA242 expressions in peripheral serum of pancreatic cancer patients were closely related to the treatment.Their joint detection can be served as independent objective evaluation reference information for the treatment efficacy and prognosis.