胃癌患者术后化疗前后血清肿瘤标志物表达及临床意义

Expression of serum tumour markers in gastric cancer patients before and after chemotherapy and their clinical significance

目的分析胃癌患者术后化疗前后血清糖类抗原125(CA125)、癌胚抗原(CEA)、组织多肽特异性抗原(TPS)、细胞角蛋白19片段抗原21-1(CYFRA21-1)、糖类抗原19-9(CA19-9)表达及临床意义。方法回顾性分析2014年4月至2016年6月收治的75例胃癌患者的临床资料,所有患者均在标准胃癌根治术(R0、D2)后接受XELOX方案化疗,化疗6个周期,并给予持续随访,随访截止时间为2018年11月。分别于化疗前、化疗结束后采集晨间空腹静脉血,双抗体夹心法(ELISA)检测血清CA125、CA19-9水平,电化学发光法检测血清CEA、TPS、CYFRA21-1水平;比较两组化疗前后上述血清肿瘤标志物水平;并参照WHO药物毒性分级标准评价不良反应发生情况;绘制Kaplan-Meier曲线分析无病生存时间;COX回归分析血清肿瘤标志物及一般临床资料(包括病理特征)对患者生存的影响。结果化疗后血清CA125、CEA、TPS、CYFRA21-1、CA19-9较化疗前显著下降(P<0.05);化疗期间不良反应主要为Ⅰ~Ⅱ度白细胞减少、血小板减少、Ⅱ度神经毒性反应,发生率分别为74.67%、14.67%、5.33%,无因不良反应而中断化疗患者;截至2019年6月,随访时间为8~53月;复发率为40.00%(30/75),中位无复发生存时间为36月,3年累积无病生存率为48.20%;经COX回归分析显示,化疗前TPS-阳性及化疗后CA125阳性、CEA-阳性、TPS阳性,淋巴结转移阳性均是患者无病生存的独立影响因素。结论胃癌手术患者化疗后血清CA125、CEA、TPS、CYFRA21-1、CA19-9较化疗前有下降趋势,且化疗前TPS-阳性及化疗后CA125阳性、CEA-阳性、TPS阳性与淋巴结转移阳性均是其无病生存的独立影响因素,值得临床重视。

Objective To analyze the expression of serum carbohydrate antigen 125(CA125),carcinoembryonic antigen(CEA),tissue polypeptide specific antigen(TPS),cytokeratin 19 fragment antigen 21-1(CYFRA21-1)and carbohydrate antigen 19-9(CA19-9)in gastric cancer patients before and after chemotherapy and their clinical significance.Methods The clinical data of 75 patients with gastric cancer who were admitted to the hospitals from April 2014 to June 2016 were retrospectively analyzed.All patients underwent XELOX chemotherapy for 6 chemotherapy cycles after standard gastric cancer radical surgery(R0,D2).They were continuously followed-up till November 2018.The morning fasting venous blood was collected before and after chemotherapy.The levels of serum CA125 and CA19-9 were detected by double antibody sandwich method(ELISA).The levels of serum CEA,TPS and CYFRA21-1 were detected by electrochemiluminescence.Before and after chemotherapy,levels of above serum tumor markers were compared between the two groups.According to WHO grading standard of drug toxicity,occurrence of adverse reactions was evaluated.Kaplan-Meier curves were drawn to analyze disease-free survival(DFS).COX regression analysis was applied to analyze effects of serum tumor markers and general clinical data including pathological features on survival of patients.Results After chemotherapy,levels of serum CA125,CEA,TPS,CYFRA21-1,and CA19-9 were significantly decreased(P<0.05).During chemotherapy,adverse reactions mainly included 74.67%of I-II degree leukopenia,14.67%of thrombocytopenia and 5.33%of II degree neurotoxicity reactions.There was no patient with chemotherapy interruption due to adverse reactions.As of June 2019,follow-up time was 8~53 months.The recurrence rate was 40.0%(30/70),the median recurrence-free survival time was 36 months and 3-year cumulative DFS rate was 48.20%.COX regression analysis showed that TPS-positive before chemotherapy,CA125-positive,CEA-positive and TPS-positive after chemotherapy,and positive lymph node metastasis were all independent influencing factors for disease-free survival of patients.Conclusion After chemotherapy,serum CA125,CEA,TPS,CYFRA21-1 and CA19-9 in gastric cancer patients show a decreasing trend.TPS-positive before chemotherapy,CA125-positive,CEA-positive and TPS-positive after chemotherapy,and positive lymph node metastasis are all independent influencing factors for disease-free survival of the patients.