血清肿瘤标志物检测在不同分化程度进展期胃癌中的表达差异及对肿瘤复发的监测意义

Expression of serum tumor markers in gastric cancer with different degrees of differentiation:Significance for monitoring tumor recurrence

背景癌胚抗原(carcinogenic antigen, CEA)、癌相关糖类抗原(carbohydrate antigen, CA)19-9及CA72-4三种血清肿瘤标志物作为辅助胃癌诊断及评估预后的指标被临床医生广泛应用,但此三种血清肿瘤标志物在不同分化程度的进展期胃癌中的临床意义是否相同还是目前临床研究中的争议点,其应用缺乏科学性,并且能否真实客观的对不同分化程度的胃癌患者做出病情评估仍缺乏有力的循证医学证据和深入研究.目的分析CEA、CA19-9及CA72-4等三种血清肿瘤标志物在不同分化程度进展期胃癌患者血清中的表达差异.方法回顾性分析2013-01/2017-10间在郑州大学第一附属医院就诊的111例胃癌患者临床病例参数、初诊及肿瘤复发后血清肿瘤标志物以及预后资料.结果初诊时CEA、CA19-9及CA72-4等三种血清肿瘤标志物的阳性率表现中分化组高于低分化组与印戒细胞癌、黏液腺癌组(χ~2=6.821, P=0.033;χ~2=10.748, P=0.005;χ~2=9.188, P=0.010).肿瘤复发后三种肿瘤标志物的阳性率表现出与初诊时相同的的趋势,即中分化组高于低分化组与印戒细胞癌、黏液腺癌组(χ~2=7.334, P=0.026;χ~2=10.700, P=0.005;χ~2=9.303,P=0.010).三种血清肿瘤标志物初诊时为阴性而肿瘤复发后转为阳性的概率(转阳率)也表现出与初诊及肿瘤复发后相同的结果(χ~2=8.673, P=0.013;χ~2=9.065, P=0.011;χ~2=8.563, P=0.014).术后首次检验值较肿瘤复发后的差值在CEA、CA19-9及CA72-4中均表现为在分化差(中分化、印戒细胞癌及黏液腺癌)的肿瘤中数值更高(F=4.175, P=0.022; F=4.167,P=0.022; F=5.801, P=0.006).结论分化程度越差的胃癌其血清CEA、CA19-9及CA72-4表达越弱,但出现肿瘤标志物阳性时的检验数值较高,此三种肿瘤标志物对于差分化胃癌患者的辅助诊断和评估肿瘤复发较中分化腺癌临床价值低.

BACKGROUND Carcinoembryonic antigen(CEA),cancer-associated carbohydrate antigen(CA)19-9,and CA72-4 are three serum tumor markers that are widely used by clinicians for auxiliary diagnosis and assessment of prognosis of gastric cancer,but their clinical significance in advanced gastric cancer with different differentiation degrees is still controversial and requires the support of strong evidence of evidence-based medicine and in-depth study.AIM To analyze the differential expression of CEA,CA19-9,and CA72-4 in the serum of patients with different pathological types of advanced gastric cancer.METHODS A retrospective analysis was performed of clinical parameters,serum tumor markers,and prognosis data of 111 patients with gastric cancer who were admitted for initial diagnosis and tumor recurrence at Zhengzhou University from January 2013 to October 2017.RESULTS The positive rates of CEA,CA19-9,and CA72-4 at the initial diagnosis were significantly higher in the moderately differentiated group than in the poorly differentiated group and the signet ring cell carcinoma and mucinous adenocarcinoma group(χ^2 = 6.821,P = 0.033;χ^2 = 10.748,P = 0.005;χ^2 = 9.188,P = 0.010).A similar trend was observed in case of tumor recurrence(χ^2 = 7.334,P = 0.026;χ^2 = 10.700,P = 0.005;χ^2 = 9.303,P = 0.010).The differences between the first postoperative test values and the values at tumor recurrence were significantly higher in poorly differentiated cases(F = 4.175,P = 0.022;F = 4.167,P = 0.022;F = 5.801,P = 0.006).CONCLUSION The worse the degree of differentiation,the weaker the expression of serum CEA,CA19-9,and CA72-4,but the positive expression value is higher.These three tumor markers in poorly differentiated adenocarcinoma have lower clinical value in the auxiliary diagnosis and evaluation of tumor recurrence than in moderately differentiated adenocarcinoma.