血清糖类抗原125对胃癌腹膜转移及其预后的预测价值

Predictive value of CA125 in peritoneal metastasis and prognosis of patients with gastric carcinoma

目的：探讨胃癌患者血清糖类抗原125（CA125）水平对腹膜转移的预测价值及其与预后的关系。方法回顾性收集山东大学齐鲁医院普通外科2003年3月至2008年9月间收治的1285例胃癌患者临床资料，分析血清 CA125水平诊断胃癌腹膜转移的敏感性、特异性及准确性；并比较CA125正常（小于或等于35μg/L）与CA125升高（大于35μg/L）患者的临床病理资料及生存情况。结果血清 CA125在诊断腹膜转移的特异性为96．0％（1011/1053），敏感性为13．8％（32/232），准确性为81．2％（1043/1285）。血清CA125升高患者腹膜转移发生率显著高于CA125正常者[43．2％（32/74）比16．5％（200/1211），P＜0．01]；CA125升高是腹膜转移的独立预测因素（RR＝3．475，95％ CI：2．124～5．685）。血清CA125升高患者术后5年总生存率为13．5％，显著低于CA125正常者的49．8％（P＜0．01）；CA125升高是胃癌患者的独立预后因素（HR＝2．049，95％CI：1．355～2．873）。结论血清CA125水平可有效预测胃癌患者腹膜转移及预后情况，建议胃癌患者应常规检查血清CA125水平。

Objective To investigate the predictive value of serum CA125 in peritoneal metastasis, and to examine the association of CA125 with the prognosis. Methods Clinical data of 1285 gastric cancer patients admitted to the Qilu Hospital from March 2003 to September 2008 were retrospectively reviewed. The sensitivity, specificity and accuracy of serum CA125 for peritoneal metastasis were analyzed. Clinicopathological characteristics and survival were compared between patients with normal serum CA125 level（≤35 μg/L） and patients with elevated serum CA125 level （〉 35 μg/L）. Results The specificity, sensitivity and accuracy of serum CA125 for peritoneal metastasis were 96.0%, 13.8% and 81.2%, respectively. A significantly higher incidence of peritoneal metastasis was observed in the patients with elevated serum CA125 level as compared to those with normal serum CA125 level （43.2% vs. 16.5%）. CA125 was an independent predictor of peritoneal metastasis （RR=3.475, 95% CI：2.124-5.685）. The 5-year overall survival rate in patients with elevated serum CA125 level was 13.5%, which was significantly lower than that of patients with normal serum CA125 level （49.8%, P〈0.01）. CA125 was an independent prognostic factor of gastric cancers （HR=2.049, 95%CI：1.355-2.873）. Conclusion Serum CA125 is useful in predicting peritoneal metastasis and prognosis of gastric cancer , which should be used as a routine examination of gastric cancer patients.