肝外胆管癌患者术前血清糖类抗原19-9和癌胚抗原水平与临床病理特征的关系

Correlation between clinicopathological features and CA19-9/CEA in patients with extrahepatic cholangiocarcinoma

目的 探讨肝外胆管癌（ECC）患者术前血清糖类抗原19-9（CA19-9）和癌胚抗原（CEA）的水平与患者临床病理特征的关系.方法 对中国医学科学院肿瘤医院收治的126例ECC患者进行回顾性分析,研究各临床病理特征与CA19-9和CEA阳性率及平均值的关系.结果 126例ECC患者术前血清CA19-9的均值为595.3 U/ml,其中91例患者的CA19-9水平高于正常值,CA19-9诊断ECC的敏感性为72.2％;CEA的均值为12.6 U/ml,其中26例患者的CEA水平高于正常值,CEA诊断ECC的敏感性为20.6％.联合检测术前血清CA19-9和CEA的水平,共有97例患者高于正常值,联合检测诊断ECC的敏感性为77.0％.CA19-9诊断ECC的敏感性与各临床病理因素无关（P＞0.05）;CEA诊断ECC的敏感性与肿瘤位置有关（P＜0.05）,对下段ECC的诊断敏感性较差.年龄＞60岁、肿瘤侵犯神经的ECC患者,CA19-9均值较高;肿瘤位于胆管中段的ECC患者,CEA均值较高（P＜0.05）.对于术前行减黄治疗的ECC患者,其减黄前后的血清CA19-9差异无统计学意义（P＞0.05）.结论 CA19-9诊断ECC的敏感性不受患者性别、年龄、血型、肿瘤部位、分化程度、肿瘤大小、T分期、有无脉管瘤栓、有无淋巴结转移、有无神经侵犯以及术前黄疸程度等因素的影响;而CEA对ECC的诊断敏感性受肿瘤部位的影响,对下段ECC的诊断敏感性较差.CA19-9的均值与ECC的局部侵犯有关,年龄＞ 60岁的患者CA19-9的均值较高.

Objective To study the correlation between clinicopathological features and serum carbohydrate antigen 19-9 （CA19-9）/ carcinoembryonic antigen （CEA） in patients with extrahepatic cholangiocarcinoma （ECC）.Methods The clinicopathological data of 126 cases of extrahepatic cholangiocarcinoma treated in our department from Jan.1999 to Dec.2012 were collected and analyzed in this study.The correlation between clinicopathological features and sensitivity of CA19-9/CEA was analyzed by chi-square test.The correlation of clinicopathological features and value of serum CA19-9/CEA was analyzed by t test and F test.Results The average value of CA19-9 before surgery in the 126 patients was 595.3 U/ml.The values of CA19-9 in 91 patients were abnormal and the sensitivity of CA19-9 was 72.2%.The average value of CEA before surgery was 12.6 U/ml.The value of CEA in 26 patients were abnormal and the sensitivity of CEA was 20.6%.The values of combined detection of serum CA19-9 and CEA before surgery were abnormal in a total of 97 cases with a sensitivity of 77.0%.There was no significant correlation between clinicopathological features and sensitivity of CA19-9 （P 〉 0.05）.The location of tumor was significantly correlated to the diagnostic sensitivity of CEA.The sensitivity of CEA to distal ECC was only 15.4%.The value of CA19-9 was relatively high in patients 〉 60-year old or with neural invasion,while CEA was higher when tumor was located in the middle of bile duct （P 〈 0.05）.There was no significant difference of serum CA19-9 before and after jaundice reduction （P 〉 0.05）.Conclusions The diagnostic sensitivity of CA19-9 is not affected by gender,age,blood type,tumor location,degree of differentiation,tumor size,T stage,vascular tumor thrombus,lymph node metastasis,perineural invasion,and preoperative jaundice.However,the diagnostic sensitivity of CEA is affected by tumor location.The value of CA19-9 is correlated with tumor invasion and is relatively high in patients above 60 years old.