癌胚抗原及糖类抗原19-9表达在Ⅱ期结直肠癌预后判断中的价值

Prognostic value of carcinoembryonic antigen and carbohydrate antigen 19-9 in patients with stageⅡcolorectal cancer

目的：探讨术前及术后癌胚抗原（CEA）和糖类抗原19-9（CA19-9）表达对Ⅱ期结直肠癌预后及复发、转移判断的价值。方法回顾性分析哈尔滨医科大学附属第二医院结直肠肿瘤外科285例行根治性手术的Ⅱ期原发性结直肠癌患者临床、病理资料。以CEA＞5ng／ml为阳性，CA19-9＞37 U／ml为阳性。术后每3个月复查CEA、CA19-9，术后2年内每3个月复查1次胸腹部CT，然后每6个月复查1次，直到术后5年。结果285例患者中，术前CEA升高99例（42.60%），CA19-9升高25例（8.77%），同时升高12例（4.21%）。CEA和CA19-9同时升高患者生存率明显下降（P＜0.05）。术后随访中复发51例，肝转移22例，肺转移10例，局部复发9例，淋巴结转移8例，腹膜转移2例。 CT、CEA、CA19-9分别单独首先发现复发、转移患者30、5、8例。CEA和CA19-9检测可以比CT检查早发现27%的复发、转移患者。结论术前CEA、CA19-9检测有助于对Ⅱ期结直肠癌患者根治性手术后的预后进行判断。术后CEA、CA19-9监测有助于早期发现肿瘤复发、转移。

Objective To evaluate the significance of the expression of carcinoembryonic antigen （CEA） and carbohydrate antigen 19-9 （CA19-9） as prognostic indicators for patients with stage Ⅱ colorectal cancer. Methods A total of 285 patients with stage Ⅱcolorectal cancer who underwent potentially curative surgery were enrolled in the study. A high CEA level was defined as a level exceeding 5 ng/ml and a high CA19-9 level was defined as a level exceeding 37 U/ml. Patients were followed up every 3 months to review CEA and CA19-9 levels. Two years later, the chest and abdominal CT examination were performed every 3 months, and then every 6 months until 5 years. Results Out of these 285 patients, 99 （42.60%） patients had high CEA levels, 25 （8.77 %） patients had high CA19-9 levels, and 12 （4.21 %） patients had both high CEA and CA19-9 levels. The overall survival rates of patients with both high CEA and CA19-9 levels were significantly worse than those of others （P〈 0.05）. During the study, 51 recurrences were diagnosed. There were 22 hepatic recurrences, 10 pulmonary recurrences, 9 local recurrences, 8 lymph node recurrences, and 2 peritoneal recurrences. CT, CEA and CA19-9 were the first abnormal examinations in 30, 5 and 8 recurrent patients, respectively. In 27 % of recurrent patients, the recurrence was detected earlier by CEA and CA19-9 than that by CT. Conclusions The detection of preoperative CEA and CA19-9 levels is useful for predicting the prognosis after potentially curative surgery in patents with stage Ⅱ colorectal cancer. For early detection of occult recurrence of colorectal cancer, tumor markers are relevant.