术前血常规联合血清肿瘤标志物在胃癌腹膜转移中的检测及临床意义

Prejudgment value of preoperative blood routine combined with serum tumor markers in peritoneal metastasis of gastric cancer

目的探讨术前血常规联合血清肿瘤标志物在胃癌腹膜转移转移中的预判价值。方法选取2015年3月至2016年3月广东医科大学附属医院胃肠外科收治的131例胃癌患者临床资料, 据病理诊断分为腹膜转移组29例, 非腹膜转移组102例。分别采用直接化学发光法及自动化血液仪检测分析术前血清肿瘤标志物与中性粒细胞与淋巴细胞比值(NLR)水平。以癌胚抗原(CEA)≥5 μg/L、糖类抗原(CA)199≥35 U/L、CA125≥35 U/L定义为阳性, NLR大于其对应截断值定义为阳性。通过建立Logistic回归分析, 绘制受试者工作特征曲线(ROC)曲线并计算曲线下面积(AUC)评价术前各血清肿瘤标志物以及与NLR联合检测在胃癌腹膜转移中的预判价值, 组间比较采用t检验。结果共纳入131例胃癌患者, 其中男92例, 女39例。腹膜转移组CA125、NLR阳性率(44.8%、82.8%)高于非腹膜转移组(6.9%、27.5%)差异有统计学意义(χ^(2)=25.158、28.854, P<0.05), 而两组CEA、CA199阳性检出率差异无统计学意义(χ^(2)=2.588、0.762, P>0.05)。单独检测时, NLR诊断胃癌腹膜转移的AUC面积最大, 与CEA、CA199差异有统计学意义(χ^(2)=2.852、2.527, P<0.05)。当NLR与CA125联合检测时AUC面积(89.9%)与NLR(83.8%)、CA125(79.1%)有统计学意义(χ^(2)=1.973、2.042, P<0.05)。结论 NLR与CA125联合诊断术前胃癌腹膜转移具有一定预判价值。

Objective To investigate the prejudgement value of preoperative blood routine combined with serum tumor markers in peritoneal metastasis of gastric cancer.Methods The clinical data of 131 patients with gastric cancer in the Affiliated Hospital,Guangdong Medical University from March 2015 to March 2016 were collected.According to the pathological diagnosis,29 cases served as peritoneal metastasis group and 102 cases as non-peritoneal metastasis group.Preoperative serum tumor markers and neutrophil to lymphocyte ratio(NLR)levels were analyzed by direct chemiluminescence and automated blood tests.The positive results were defined when carcinoma embryonic antigen(CEA)≥5μg/L,carbohydrate antigen(CA)199≥35 U/L,CA125≥35 U/L,and NLR greater than its corresponding cutoff value.By establishing logistic regression analysis,the receiver operator characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to evaluate the prejudgment value of preoperative serum tumor markers and combined detection with NLR in gastric cancer peritoneal metastasis.Results A total of 131 patients with gastric cancer were enrolled,including 92 males and 39 females.The positive rate of CA125 and NLR in the peritoneal metastasis group(44.8%and 82.8%)was significantly higher than that in the non-peritoneal metastasis group(6.9%and 27.5%χ^(2)=25.158,28.854,P<0.05),but there was no significant difference in the positive rate of CEA and CA199 between the two groups(χ^(2)=2.588,0.762,P>0.05).In single detection,the AUC of NLR diagnosis of gastric cancer peritoneal metastasis was the biggest,which was significantly different from the CEA and CA199(χ^(2)=2.852,2.527,P<0.05).The AUC of combined detection of NLR and CA125(89.9%)was significantly different from NLR(83.8%)and CA125(79.1%)(χ^(2)=1.973,2.042,P<0.05).Conclusion The combination of NLR and CA125 in the diagnosis of preoperative gastric cancer with peritoneal metastasis has a certain prejudgement value.