CA19-9在西妥昔单抗联合一线化疗治疗转移性结直肠癌疗效及预后评价中的意义

Significance of CA19-9 in monitoring response to cetuximab combined with first-line chemotherapy for patients with metastatic colorectal cancer

目的旨在研究CA19-9用于西妥昔单抗联合一线化疗治疗转移性结直肠癌疗效评价及在预后预测中的意义。方法回顾2012年6月-2017年6月在我中心接受以西妥昔单抗联合FOLFOX4/FOLFIRI为一线方案治疗的RAS基因野生型转移性结直肠癌患者78例,分析其治疗过程中CA19-9疗效评价与RECIST标准疗效评价的关系,并通过KaplanMeier曲线分析基线CA19-9水平正常(n=30例)和基线CA19-9水平升高(n=48例)患者的无进展生存期(progression-free survival,PFS)。结果与RECIST标准相比,CA19-9用于评价疾病控制率(disease control rate,DCR)的灵敏度为87.7%,特异度为70.6%,阳性预测值为86.5%,阴性预测值为72.7%,准确度为82.2%;基线CA19-9水平正常患者较基线CA19-9水平升高者PFS更长(9.40个月vs 7.45个月,P=0.010)。结论西妥昔单抗联合一线化疗治疗转移性结直肠癌时,CA19-9可作为疗效评价的重要辅助指标,并对预后有一定预测作用。

Objective To evaluate prognosis prediction value of CA19-9 for metastatic colorectal cancer treated by cetuximab and first-line chemotherapy.Methods Seventy-eight patients with wild-type RAS metastatic colorectal cancer receiving cetuximab plus FOLFOX4 or FOLFIRI chemotherapy in our hospital from June 2012 to June 2017 were included in our study,and the relationship between serum CA19-9 and RECIST criteria throughout the treatment course was analyzed.Furthermore,Kaplan-Meier curve was applied to analyze the progression-free survival (PFS)of patients with normal baseline CA19-9level (n=30)and patients with elevated baseline CA19-9 level (n=48).Results Compared with the RECIST standard,the sensitivity and specificity of CA19-9 to evaluate the disease control rate (DCR) were 87.7% and 70.6%,and positive predictive value and negative predictive value were 86.5% and 72.7%,with an accuracy of 82.2%.Patients with normal baseline CA19-9 level had longer PFS than those with elevated CA19-9 levels (9.40 months vs 7.45 months,P=-0.010).Conclusion Our results highlight the importance of CA19-9 in assessing the efficacy of cetuximab combined with first-line chemotherapy and predicting the prognosis of patients with metastatic colorectal cancer.