肿瘤标志物对肝内胆管细胞癌患者发生淋巴结转移的预测效果研究

Study on the predictive effect of tumor markers on lymph node metastasis in patients with intrahepatic cholangiocarcinoma

目的探讨肿瘤标志物(CEA、AFP、CA19-9、CA125、CA211和CA242)对肝内胆管细胞癌(ICC)患者发生淋巴结转移的预测效果。方法选取我院2013年2月至2018年2月收治的102例ICC患者为研究对象。根据手术后病理学检查结果是否存在淋巴转移分为淋巴结转移组(n=36)和非淋巴结转移组(n=66)。术前所有患者均行肿瘤标志物检测。结果淋巴结转移组血清CA19-9、CA125、CA211和CA242阳性率分别为83.3%、47.2%、77.8%和69.4%,非淋巴结转移组分别为50.0%、30.3%、59.1%和48.5%,两组比较差异有统计学意义(P<0.05)。两组血清CEA和AFP阳性率比较差异无统计学意义(P>0.05)。淋巴结转移组血清CA19-9、CA125、CA211和CA242水平分别为(298.5±102.5)U/L、(71.5±33.5)U/L、(7.3±6.2)μg/L和(75.6±33.5)U/L,非淋巴结转移组分别为(55.9±26.5)U/L、(16.9±8.5)U/L、(3.8±2.1)μg/L和(13.5±6.8)U/L,两组比较差异有统计学意义(P<0.05)。两组血清CEA和AFP水平比较差异无统计学意义(P>0.05)。采用ROC曲线评价术前血清CA19-9、CAl25、CA211和CA242对淋巴结转移的预测价值见图1,其曲线下面积(AUC)分别为0.772(95%CI 0.666~0.878,0.000)、0.778(95%CI 0.678~0.879,0.000)、0.762(95%CI 0.651~0.889,0.000)和0.831(95%CI 0.729~0.932,0.000)。血清CA19-9、CAl25、CA211和CA242预测ICC患者淋巴结转移的性临界值分别为145.9 U/L、38.9 U/L、6.2μg/L和45.6U/L,敏感度分别为64.7%、72.5%、67.6%和76.5%,特异性分别为69.6%、65.7%、77.5%和79.4%。结论术前血清CA19-9、CAl25、CA211和CA242可作为预测ICC患者发生淋巴结转移的重要指标,值得临床推广。

Objective To investigate the predictive effect of tumor markers(CEA,AFP,CA19-9,CA125,CA211 and CA242)on lymph node metastasis in patients with intrahepatic cholangiocarcinoma(ICC).Methods 102 ICC patients who were admitted to our hospital from February 2013 to February 2018 were selected as the study subjects.Lymph node metastasis group(n=36)and non-lymph node metastasis group(n=66)were classified according to whether or not lymph node metastasis was found after surgery.All patients were examined before surgery for tumor markers.Results The positive rates of serum CA19-9,CA125,CA211,and CA242 in lymph node metastasis group were 83.3%,47.2%,77.8%,and 69.4%,respectively.The non-lymph node metastasis group was 50.0%,30.3%,59.1%,and 48.5%,respectively.And there were statistical significantly differences(P<0.05).There were no statistical significantly differences in the positive rate of serum CEA and AFP between the two groups(P>0.05).The levels of serum CA19-9,CA125,CA211,and CA242 in the lymph node metastasis group were(298.5±102.5)U/L,(71.5±33.5)U/L,(7.3±6.2)μg/L,and(75.6±33.5)U/L,non-lymph node metastases were(55.9±26.5)U/L,(16.9±8.5)U/L,(3.8±2.1)μg/L,and(13.5±6.8)U/L,respectively.There were statistical significantly differences between the two groups(P<0.05).There were no statistical significant difference in serum CEA and AFP levels between the two groups(P>0.05).The predictive value of preoperative serum CA19-9,CA25,CA211,and CA242 for lymph node metastasis using the ROC curve and the area under the curve(AUC)was 0.772(95%CI 0.666 to 0.878,P=0.000),0.778,respectively.(95%CI 0.678 to 0.879,P=0.000),0.762(95%CI 0.651 to 0.889,P=0.000)and 0.831(95%CI 0.729 to 0.932,P=0.000).Serum CA19-9,CA25,CA211,and CA242 predicted the criticality of lymph node metastasis in ICC patients was 145.9 U/L,38.9 U/L,6.2μg/L,and 45.6 U/L,respectively,and the sensitivity was 64.7%and 72.5%,respectively.,67.6%and 76.5%,with specificities of 69.6%,65.7%,77.5%,and 79.4%,respectively.Conclusion Preoperative serum CA19-9,CA25,CA211,and CA242 may serve as important predictors of lymph node metastasis in patients with ICC and are worthy of clinical promotion.