糖类抗原19-9对Ⅳ期结直肠癌预后的预测价值

Prognostic value of serum CA19-9 in patients with stage Ⅳ colorectal cancer

目的评价影响Ⅳ期结直肠癌患者的预后因素及糖类抗原19-9(CA19-9)对该期患者预后的预测价值。方法收集2012年-2015年就诊的265例Ⅳ期结直肠癌患者的临床病理资料,采用Kaplan-Meier生存曲线对可能影响患者生存期的参数进行单因素分析,Log-rank法进行患者总生存率的比较,分析有意义(P<0.05)的变量纳入Cox比例风险回归模型进行多因素分析。结果单因素和多因素分析显示血清CA19-9水平、是否接受手术和转移时期是影响Ⅳ期结直肠癌患者预后的独立危险因素。异时性转移组中,CA19-9升高患者发生多器官转移高于CA19-9正常患者(24.0%vs4.3%,P<0.01);同时性转移组中,CA19-9升高患者发生KRAS突变者高于CA19-9正常患者,差异均有统计学意义(47.1%vs10.0%,P<0.05)。结论血清CA19-9水平是影响Ⅳ期结直肠癌患者预后的独立危险因素,Ⅳ期结直肠癌CA19-9升高患者的预后更差。

Objective To assess the prognostic factors and the predictive value of serum CA19 - 9 in patients with stage Ⅳ colorectal cancer. Methods Clinical data of 265 patients who were diagnosed as stage Ⅳcolorectal cancer from 2012 to 2015 was analyzed retrospectively. The Kaplan - Meier survival curve was used to analyze the clinical pathological parameters which might affect the survival time of the patients, the Log - rank method was used to compare the survival rate. The significant variables ( P < 0. 05) were analyzed in the Cox proportional risk regression model for multivariate analysis. Results The univariate analysis showed that the overall survival rate was related to the level of serum CA19 - 9, surgery and the synchronous metastasis. The multivariate analysis showed that the level of serum CA19 - 9, surgery and the synchronous metastasis were independent prognostic factors of patients with stage Ⅳ colorectal cancer. In the metachronous metastasis group, the incidence of multiple organ metastasis in patients with elevated CA19 - 9 was higher than that in patients with normal CA19 - 9 ( 24. 0% vs 4. 3%, P < 0. 01). In the synchronous metastasis group, the incidence of KRAS mutation in patients with elevated CA19 - 9 was higher than that in patients with normal CA19 - 9, with the differences statistically significant ( 47. 1% vs 10. 0%, P < 0. 05). Conclusion The level of serum CA19 - 9, surgery and the synchronous metastasis were independent prognostic factors of patients with stage Ⅳ colorectal cancer. The prognosis of stage Ⅳ colorectal cancer patients with elevated serum CA19 - 9 is worse than that of patients with normal serum CA19 - 9.