不同肿瘤标志物在结肠癌患者诊断及预后预测中的价值

Value of different tumor markers for the diagnosis and prognosis prediction of colon cancer in patients

目的综合分析结肠癌患者血清肿瘤标志物,包括糖类抗原724(Carbohydrate antigen724,CA724)、细胞角蛋白19的可溶性片段(Cytokeratin 19 fragment antigen,CYFRA21-1)、糖类抗原199(Carbohydrate antigen199,CA199)、癌胚抗原(Carcinoembryonic antigen,CEA)在疾病诊断及预后评估中的临床价值。方法回顾性分析诸暨市中心医院2018年1月至2020年12月收治的结肠癌患者160例及同期良性结肠息肉患者156例受检者的临床资料,并将160例结肠癌患者纳入观察组,将156例良性结肠息肉患者纳入对照组。患者均接受上述4种肿瘤标志物检测。比较两组患者肿瘤标志物水平;肿瘤标志物单项及四项联合检测的阳性率;结肠癌患者在不同病理分期进行肿瘤标志物水平观察比较。1年后进行随访,对比不同预后情况患者血清相关肿瘤标志物水平。结果观察组CA199阳性率[85.63%(137/160)]、CEA阳性率[86.88%(139/160)]、CYFRA21-1阳性率[71.88%(115/160)]、CA724阳性率[85.00%(136/160)]及四项联合检测的阳性率[95.63%(153/160)]均显著高于对照组(χ^(2)=8.64、10.28、8.33、9.93、7.27,均P<0.001);Ⅲ~Ⅳ期结肠癌患者血清CA199[(58.96±13.59)U/mL]、CEA[(38.69±11.84)μg/L]、CYFRA21-1[(14.78±3.68)μg/L]、CA724[(23.68±5.38)U/mL]表达均显著高于Ⅰ~Ⅱ期患者[(48.35±9.03)U/mL、(23.96±12.25)μg/L、(9.57±2.53)μg/L、(13.02±4.32)U/mL](t=10.29、12.02、8.47、10.54,均P<0.001);1年后随访,结肠癌患者复发、转移组的血清CA199[(38.68±3.04)U/mL]、CEA[(17.12±4.96)μg/L]、CYFRA21-1[(8.94±2.32)μg/L]、CA724[(11.22±1.94)U/mL]表达均显著高于未复发组[(30.02±2.95)U/mL、(3.75±1.06)μg/L、(3.06±1.15)μg/L、(6.28±1.53)U/mL](t=8.73、11.02、7.72、7.57,均P<0.001)。结论结肠癌患者血清CEA、CA199、CA724及CYFRA21-1水平可作为诊断及预后预测的重要指标。

Objective To comprehensively analyze the clinical values of serum tumor markers of colon cancer,including carbohydrate antigen 724(CA724),cytokeratin 19 fragment antigen(CYFRA21-1),carbohydrate antigen199(CA199)and carcinoembryonic antigen(CEA)in the diagnosis and prognosis prediction of colon cancer in patients.Methods The clinical data of 160 patients with colon cancer who received treatment in Zhuji Central Hospital from January 2018 to December 2020(observation group)and the clinical data of 156 patients with benign colon polyps who concurrently received physical examination(control group)were retrospectively analyzed.All patients underwent CA724,CYFRA21-1,CA199 and CEA tumor marker screening.The levels of tumor markers,the positive rate of a single tumor marker,and the positive rate of a combination of four markers were compared between the control and observation groups.The levels of tumor markers were compared among different pathological stages.The levels of serum tumor markers were compared among patients with different prognoses based on 1-year follow-up data.Results CA199-positve rate,CEA-positive rate,CYFRA21-1-positve rate,CA724-positive rate,and the positive rate of a combination of four tumor markers were 85.63%(137/160),86.88%(139/160),71.88%(115/160),85.00%(136/160),and 95.63%(153/160),respectively,which were significantly higher than those in the control group(χ^(2)=8.64,10.28,8.33,9.93,7.27,all P<0.001).Serum CA199,CEA,CYFRA21-1 and CA724 levels in patients with stage III-IV colon cancer were(58.96±13.59)U/mL,(38.69±11.84)μg/L,(14.78±3.68)μg/L,(23.68±5.38)U/mL,respectively,which were significantly higher than those in patients with stage I-II colon cancer[(48.35±9.03)U/mL,(23.96±12.25)μg/L,(9.57±2.53)μg/L,(13.02±4.32)U/mL,t=10.29,12.02,8.47,10.54,all P<0.001].One-year follow-up results showed that serum levels of CA199,CEA,CYFRA21-1,CA724 in patients with recurrence and metastasis of colon cancer were(38.68±3.04)U/mL,(17.12±4.96)μg/L,(8.94±2.32)μg/L,(11.22±1.94)U/mL,which were significantly higher than those in patients without recurrence of colon cancer[(30.02±2.95)U/mL,(3.75±1.06)μg/L,(3.06±1.15)μg/L,(6.28±1.53)U/mL,t=8.73,11.02,7.72,7.57,all P<0.001].Conclusion Serum levels of CEA,CA199,CA724 and CYFRA21-1 can be used as important indicators for diagnosis and prognosis prediction of colon cancer.