临床病理学分析结合CEA、CA19-9与CA125检测对诊断胃癌术后腹膜转移的意义

The Analysis of Clinicopathologic Features and CEA,CA19-9 and CA125 Levels of Peritoneal Metastasis in Postoperative Gastric Cancer Patients

目的研究胃癌术后腹膜转移和其临床病理学特征的相关关系,进一步探讨肿瘤标志物CEA、CA19-9及CA125在胃癌术后腹膜转移诊断中的作用。方法 2010年至2016年因胃癌术后在本院复查的、相关临床资料齐全的181名患者纳入本研究,按照有无腹膜转移分为两组,比较两组患者的性别、年龄、肿瘤部位、Lauren分型、组织学分级及肿瘤分期与临床病理学特征的关系。进一步比较两组间血清CEA、CA19-9及CA125的差异,采用ROC曲线分析方法比较这三种肿瘤标志物诊断胃癌术后腹膜转移的诊断效能。结果胃癌术后发生腹膜转移组患者原发病灶的浸润深度更深、分化程度更低、淋巴结转移数更多、肿瘤分期更晚,且Lauren分型多为弥漫型,差异有统计学意义(P<0.05),而两组的性别、年龄及肿瘤发生部位的差异无统计学意义(P>0.05)。胃癌术后腹膜转移组的血清CEA、CA19-9和CA125水平均高于无腹膜转移组,差异有统计学意义(P<0.05),三者中CA125的诊断效能最高。CEA+CA19-9+CA125联合检测诊断腹膜转移的灵敏度高达91.7%,高于CA19-9+CA125联合检测及三者单独检查,差异有统计学意义(P<0.05)。结论胃癌原发病灶T分期为T3和T4期、N分期为N2和N3期、中低分化、弥漫型胃癌及Ⅲ、Ⅳ期患者术后发生腹膜转移的几率较高,术后密切随访血清CEA、CA19-9及CA125水平可早期诊断腹膜转移,采取有效的治疗方案。

Objective To investigate the correlation between peritoneal metastasis in postopera-tive gastric cancer patients and clinicopathoigic features and to explore the diagnostic value of serum CEA,CA19-9 and CA125 levels in peritioneal metastasis in postoperative gastric cancer patients. Methods A total of 181 cases of postoperative gastric cancer patients were included in this study. According to the presence of peritoneal metastasis,all patients were divided into two groups. Patient sex,age,tumor location,Lauren types,histological grade,T-stage,N-stage,M-stage and tumor stage were compared. CA19-9 and CA125 levels were compared between the two groups. The diagnostic efficiency of three methods was also compared by ROC curve analysis method. Results The characteristics of peritoneal metastasis in postoperative gastric cancer were deeper depth of invasion,lower degree of differentiation with diffused type in Lauren Classsification,greater number of lymph node metastasis,and later tumor stagewhen compared with postoperative gastric cancer without peritoneal metastasis,the differences between two groups were statistically significant（ P 〈0. 05）. There were no differences in sex,age and tumor location between two groups（ P〉 0. 05）. CEA,CA19-9 and CA125 levels in the group with peritoneal metastasis were significantly higher than the group without peritoneal metastasis（ P〈 0. 05）. Diagnosis efficiency of CA125 was the best. The sensitivity of CEA,CA19-9 and CA125 combined detection was 91. 7% which was higher than CA19-9 and CA125 combined detection and independent detection of the three tumor markers. Conclusion The chances of peritoneal metastasis were higher in patients with T3,T4,N2,N3,moderately and poor-differentiated,diffused type-gastric cancer and Ⅲ-Ⅳstage. Closely following-up with CEA,CA19-9 and CA125 levels can be valuable in early diagnosis of peritoneal metastasis and can provide early treatments.