围术期癌胚抗原联合术后糖类抗原19-9及糖类抗原125预测Ⅰ~Ⅲ期结直肠癌预后的价值

Value of perioperative carcinoembryonic antigen combined with carbohydrate antigen 19-9 and carbohydrate antigen 125 in predicting prognosis of patients with colorectal cancer in stagesⅠtoⅢ

目的探讨Ⅰ~Ⅲ期结直肠癌(CRC)患者围术期癌胚抗原(CEA)水平变化与临床病理特征、疾病进展的关系,分析术后糖类抗原125(CA125)、糖类抗原19-9(CA19-9)对评估术后CEA阴性患者预后的价值。方法选取2013年1月—2016年12月苏州大学附属第一医院接受根治性手术的结直肠癌患者287例。应用χ^(2)检验、Kaplan-Meier法、Log-rank检验、Cox风险回归模型分析患者围术期CEA、术后CA125联合CA19-9与临床病理特征及预后的关系。结果所有患者中位随访时间为49个月。术后CEA阳性与不良T分期(T_(3)、T_(4))、N分期(N_(1)、N_(2))和TNM分期均显著相关(P<0.01),与癌结节和神经侵犯显著相关(P<0.05)。单因素分析发现,N分期、TNM分期、肿瘤分化程度、癌结节、脉管癌栓、神经侵犯、CA19-9和CA125是影响无病生存期(DFS)的相关因素(P<0.05),N分期、肿瘤分化程度、癌结节、CA19-9和CA724是影响总生存期(OS)的相关因素(P<0.05)。多因素分析显示,术后CA125阳性(P<0.001)和癌结节(P<0.05)是术后CEA阴性患者DFS的独立预后危险因素,癌结节(P<0.05)和肿瘤分化程度(P<0.05)是影响OS的重要因素。术前和术后CEA均阴性组患者的DFS和OS高于术前或术后CEA阳性组,术后CEA降至正常组的DFS、OS高于术后CEA未降至正常组,术后CA19-9和CA125均阴性者DFS、OS高于术后CA19-9或CA125阳性者,差异均有统计学意义(P<0.05或P<0.01)。结论围术期血清CEA水平变化直接影响CRC患者的预后,术前及术后CEA阴性或者术后早期CEA降至正常的患者预后较好。对于术后CEA阴性患者,术后CA125或CA19-9表达阳性提示术后复发、转移风险增高,预后不佳。

Objective To explore the relationship between the change of perioperative carcinoembryonic antigen(CEA)level and clinical features,disease progression in patients with stageⅠtoⅢcolorectal cancer,and to analyze the values of postoperative carbohydrate antigen 125(CA125)and carbohydrate antigen 19-9(CA19-9)in evaluating prognosis of patients with postoperative CEA negative result.Methods Totally 287 patients with radical operation for colorectal cancer from January 2013 to December 2016 in the First Hospital Affiliated to Soochow University were selected.Chisquare test,Kaplan-Meier method,Log-rank test,and Cox risk regression model were used to analyze the relationships between the perioperative CEA,combination of postoperative CA125 and CA19-9 and clinical pathological characteristics and prognosis.Results The median follow-up time was 49 months.Postoperative CEA positive was significantly correlated with adverse T stage(T_(3),T_(4)),N stage(N_(1),N_(2))and TNM stage(P<0.01),and was significantly correlated with cancer nodule and nerve invasion(P<0.05).Univariate analysis showed that N stage,TNM stage,tumor differentiation,tumor nodule,vascular tumor thrombus,nerve invasion,CA19-9 and CA125 were the related factors affecting disease free survival(DFS)(P<0.05),and N stage,tumor differentiation,tumor nodule,CA19-9 and CA724 were the related factors affecting overall survival(OS)(P<0.05).Multivariate analysis showed that postoperative CA125 positive(P<0.001)and tumor nodule(P<0.05)were independent prognostic factors for DFS in patients with CEA negative.Tumor nodule(P<0.05)and tumor differentiation(P<0.05)were important factors affecting OS.The DFS and OS of patients with both preoperative and postoperative CEA negative were significantly higher than those of patients with preoperative or postoperative CEA positive,the DFS and OS of patients with postoperative CEA returning to normal were significantly higher than those of patients without postoperative CEA returning to normal,and the DFS and OS of patients with both postoperative CA19-9 and CA125 negative were higher than those of patients with postoperative CA19-9 or CA125 positive(P<0.05 or P<0.01).Conclusion The change of serum CEA level in perioperative period can directly affect the prognosis of CRC patients,and the prognosis of patients with both preoperative and postoperative CEA negative or CEA decreasing to normal level in the early postoperative period are better.For patients with CEA negative after operation,the positive expression of CA125 or CA19-9 after operation indicates that the risks of recurrence and metastasis are increasing,and the prognosis is poor.