结直肠癌术后血清CTCs、CA125、CEA及CA19-9水平与复发或转移的相关性研究

CORRELATION BETWEEN LEVELS OF SERUM CTCS,CA125,CEA AND CA19-9 AND RECURRENCE OR METASTASIS AFTER COLORECTAL CANCER SURGERY

目的分析结直肠癌术后血清循环肿瘤细胞(circulating tumor cells,CTCs)、糖类抗原125(carbohydrateantigen,CA125)、癌胚抗原(carcinoembryonic antigen,CEA)、糖类多肽抗原19-9(carbohydrate antigen 19-9,CA19-9)水平与复发或转移的相关性。方法按纳入与排除标准筛选2012年1月-2016年12月在本院接受结直肠癌根治术的97例结直肠癌患者作为研究对象,查阅临床病例资料,采集患者临床病理特征并比较不同临床病理特征患者血清CTCs、CA125、CEA及CA19-9水平,绘制Kaplan-Meier生存曲线分析其无进展(复发或转移)生存率,采用受试者工作特征(ROC)曲线分析血清CTCs、CA125、CEA及CA19-9水平对结直肠癌患者术后复发或转移的预测价值;并比较不同血清CTCs、CA125、CEA及CA19-9水平患者的无进展生存率。结果不同性别、年龄、肿瘤位置、肿瘤组织学分型、肿瘤大小、术后治疗方案患者血清CTCs、CA125、CEA及CA19-9比较,差异均无统计学意义(均P>0.05);但血清CTCs、CA125、CEA及CA19-9随肿瘤分期增加而上升,随着分化程度增加而下降,且淋巴结转移阳性患者血清CTCs、CA125、CEA及CA19-9显著高于淋巴结转移阴性患者(P<0.05);97例结直肠癌患者1年、2年、3年、5年无进展生存率分别为92.50%、86.70%、82.90%、67.90%;以12.56ng/ml为血清CEA阈值,其预测结直肠癌患者复发转移的敏感度为80.60%、特异度为81.80%;联合预测时特异度上升至90.90%,但敏感度下降至74.20%;且CTCs阳性、CA125阳性、CEA阳性、CA19-9阳性患者无进展生存率显著低于CTCs阴性、CA125阴性、CEA阴性、CA19-9阴性患者(P<0.05)。结论结直肠癌术后血清CTCs、CA125、CEA及CA19-9水平与复发或转移有一定关联,或可作为预测结直肠癌术后复发或转移的重要肿瘤生物标记物。

Objective To analyze the correlation between levels of circulating tumor cells(CTCs),carbohydrate antigen(CA125),carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9) and recurrence or metastasis after colorectal cancer surgery.Methods From January 2012 to December 2016,ninety-seven patients with colorectal cancer who underwent radical resection in West China-Guang’an Hospital,Sichuan University were selected as subjects.The clinical data and clinicopathological features were of patients were collected.Serum CTCs,CA125,CEA and CA19-9 levels were compared among patients with different clinicopathological features.Kaplan-Meier survival curves were used to analyze progression(recurrence or metastasis)-free survival.The predictive value of serum CTCs,CA125,CEA and CA19-9 levels for recurrence or metastasis after colorectal cancer surgery was analyzed by receiver operating characteristic(ROC) curves.The progression-free survival rates of patients with different levels of serum CTCs,CA125,CEA and CA19-9 were compared.Results There was no significant difference in serum CTCs,CA125,CEA and CA19-9 between different gender,age,tumor location,tumor histological types,tumor sizes or postoperative treatment methods(P>0.05).Serum CTCs,CA125,CEA and CA19-9 increased with the increase of tumor stage,and decreased with the increase of differentiation degree.Serum CTCs,CA125,CEA and CA19-9 in patients with positive lymph node metastasis were significantly higher than those in patients with negative lymph node metastasis(P<0.05).The 1-year,2-year,3-yearand 5-year progression-free survival rates of 97 patients with colorectalcancer were 92.50%,86.70%,82.90%and 67.90%,respectively.With 12.56 ng/ml as the threshold of serum CEA,the sensitivity and specificity for predicting recurrence and metastasis of colorectal cancer were 80.60% and 81.80%.The specificity of joint prediction was 90.90%,but the sensitivity was 74.20%.The progression-free survival rate of CTCs positive,CA125 positive,CEA positive and CA19-9 positive patients was significant lower than that of CTCs negative,CA125 negative,CEA negative and CA19-9 negative patients(P<0.05).Conclusion The levels of serum CTCs,CA125,CEA and CA19-9 in patients with colorectal cancer are related to recurrence or metastasis after surgery.They can be used as biomarkers for predicting recurrence or metastasis of colorectal cancer.