CTC、CEA、CA125 联合检测在结直肠癌中的临床价值

Clinical application value of CTC combined determination with CEA and CA125 in colorectal cancer

目的探讨循环肿瘤细胞(CTC)、癌胚抗原(CEA)及糖类抗原(CA)125联合检测在结直肠癌中的临床价值。方法选取结直肠癌患者115例(结直肠癌组)、结直肠息肉患者99例(息肉组)。检测所有研究对象甲胎蛋白(AFP)、CEA、CA125、CA19-9、CA15-3、CA72-4及CTC。根据CTC数量将结直肠癌患者分为Ⅰ组(CTC为0个/7.5 mL)、Ⅱ组(CTC为1~4个/7.5 mL)、Ⅲ组(CTC≥5个/7.5 mL)。根据结直肠癌TNM分期将结直肠癌患者分为0~Ⅱ期组、Ⅲ期组、Ⅳ期组。采用Logistic回归分析评估结直肠癌的危险因素。采用受试者工作特征(ROC)曲线评价各项指标鉴别诊断结直肠癌的价值。结果Ⅰ组血清CEA、CA19-9、CA72-4水平低于Ⅱ组和Ⅲ组(P<0.05),血清AFP水平低于Ⅱ组(P<0.05),血清CA125水平低于Ⅲ组(P<0.05)。Ⅱ组与Ⅲ组之间各项指标差异均无统计学意义(P>0.05)。息肉组、结直肠癌组CTC数量及血清CEA、CA125、CA19-9、CA72-4水平差异均有统计学意义(P<0.05),血清AFP、CA15-3水平各组间差异均无统计学意义(P>0.05)。结直肠癌TNM分期0~Ⅱ期组与Ⅳ期组之间、Ⅲ期组与Ⅳ期组之间CA19-9和CA724水平差异均有统计学意义(P<0.05);0~Ⅱ期组与Ⅳ期组CTC差异有统计学意义(P<0.05);3组之间血清CEA、AFP、CA125、CA15-3水平差异均无统计学意义(P>0.05)。Logistic回归分析结果显示,CEA、CA125、CTC是结直肠癌发生的危险因素[比值比(OR)值分别为1.368、1.135、5560619.101,95%可信区间(CI)分别为1.120~1.672、1.037~1.244、0.000~2.129×10^(214)]。ROC曲线分析结果显示,CEA、CA125、CTC单项及联合检测鉴别诊断结直肠癌的曲线下面积(AUC)分别为0.840、0.741、0.822、0.943。结论联合检测CTC、CEA、CA125在结直肠癌中有较大的临床价值。

Objective To investigate the clinical application value of the combined determination of circulating tumor cell(CTC)number,carcinoembryonic antigen(CEA)and carbohydrate antigen(CA)125 in colorectal cancer.Methods A total of 115 patients with colorectal cancer(colorectal cancer group)and 99 patients with colorectal polyps(polyp group)were enrolled.All research subjects were determined for alpha-fetoprotein(AFP),CEA,CA125,CA19-9,CA15-3,CA72-4 and CTC number.According to CTC number,the patients with colorectal cancer were classified into groupⅠ(CTC 0/7.5 mL),groupⅡ(CTC 1-4/7.5 mL)and groupⅢ(CTC≥5/7.5 mL).According to TNM stage of colorectal cancer,the colorectal cancer patients were classified into 0-Ⅱstage group,Ⅲstage group andⅣstage group.Logistic regression analysis was used to evaluate the risk factors of colorectal cancer.Receiver operating characteristic(ROC)curve was used to evaluate the value of various indicators in the differential diagnosis of colorectal cancer.Results The levels of serum CEA,CA19-9 and CA72-4 inⅠgroup were lower than those inⅡgroup andⅢgroup(P<0.05),the level of serum AFP was lower than that inⅡgroup(P<0.05),and the level of serum CA125 was lower than that inⅢgroup(P<0.05).There was no statistical significance in the indicators betweenⅡgroup andⅢgroup(P>0.05).There was statistical significance in CTC number and serum CEA,CA125,CA19-9 and CA72-4 levels between polyp group and colorectal cancer group(P<0.05),while there was no statistical significance in serum AFP and CA15-3 levels among the groups(P>0.05).There was statistical significance in CA19-9 and CA724 levels between TNM stage 0-Ⅱgroup and stageⅣgroup and between stageⅢgroup and stageⅣgroup(P<0.05).There was statistical significance in CTC number between stage 0-Ⅱgroup and stageⅣgroup(P<0.05).There was no statistical significance in serum CEA,AFP,CA125 and CA15-3 levels among the 3 groups(P>0.05).Logistic regression analysis showed that the odds ratios(OR)of CEA,CA125 and CTC number were 1.368,1.135 and 5560619.101,respectively.95%Confidence intervals(CI)were 1.120-1.672,1.037-1.244,0.000-2.129×10^(214),respectively.ROC curve analysis showed that the areas under curves(AUC)of CEA,CA125,CTC number single determinations and combined determination were 0.840,0.741,0.822 and 0.943,respectively.Conclusions The combined determination of CTC number,CEA and CA125 plays a role for patients with colorectal cancer.