4种血清肿瘤标志物水平对结直肠癌术前分期的意义

Application of Serum Levels of Four Tumor Markers in Preoperative Staging of Colorectal Cancer

【目的】探讨结直肠癌术前4种常见血清肿瘤标志物水平与肿瘤浸润深度、淋巴结转移的关系，评价其在结直肠癌术前分期的应用价值。【方法】回顾性分析本院胃肠外科184例行手术治疗的结直肠癌患者的术前4项血清肿瘤标志物癌胚抗原（CEA）、糖类抗原（CA）199、CA242、CA724的水平和临床病理资料。【结果】单因素分析结果表明结直肠癌肿瘤浸润深度与术前CEA、CA199、CA724水平、肿瘤大体类型、最大径、分化程度、脉管癌栓、淋巴结转移及肿瘤标志物阳性个数有关（P〈0．05）。淋巴结转移与术前CEA、CA199、CA242、CA724水平、肿瘤大体类型、最大径、分化程度、脉管癌栓、浸润深度及肿瘤标志物阳性数有关（P〈0．05）。多因素分析表明结直肠癌患者术前CEA水平、肿瘤直径、淋巴结转移是肿瘤浸润深度的独立危险因素；肿瘤浸润深度和脉管癌栓是淋巴结转移的独立危险因素。4种标志物联合检测其诊断的灵敏度、特异度和准确度分别为71．15％、92．95％、81．92％。【结论】术前血清CEA水平是影响结直肠癌T分期的独立危险因素，术前多种肿瘤标志物的联合检测对结直肠癌的分期及预后有指导意义。

[Objective]To investigate the relationship between preoperative serum levels of four common tumor markers and the depth of tumor invasion and lymph node metastasis, further to evaluate its application in the preoperative staging in patients with colorectal cancer. [Methods] The levels of preoperative serum tumor markers （CEA、 CA199. CA242 、 CA724） and clinicopathologic features in 184 patients with intestinal surgery in the Central Hospital of Shaoyang were retrospectively evaluated. [Results]The depth of tumor invasion in patients with colorectal cancer was significantly related to preoperative CEA,CA199,CA242 levels, macroscopic type, tumor size, differentiation, lymphovascular invasion, lymph node metastasis and the number of positive tumor markers （ P 〈0.05）. Lymph node metastasis was significantly correlated with preoperative CEA.CA199. CA242. and CA724 levels, macroscopic type, tumor size, differentiation, lymphovascular invasion, depth of tumor invasion, and the number of positive tumor markers （ P 〈0.05）. Multivariate regression analysis showed that preoperative CEA level, tumor size and lymph node metastasis were independent factors of depth of tumor invasion in patients with colorectal cancer. The depth of invasion and lymphovascular invasion were independent factors in patients with colorectal cancer. [Conclusion]Preoperative CEA level seems to predict the depth of tumor invasion in the patients with colorectal cancer. The values of multiple preoperative tumor marker levels have guiding significance in predicting the stage and prognosis of colorectal cancer, however.