健康体检人群血清癌胚抗原轻度升高在肿瘤预测中的应用价值

Application value of mildly increase of carcinoembryonic antigen in tumor prediction of healthy physical examination people

目的探讨血清癌胚抗原(CEA)轻度升高在健康体检人群肿瘤预测中的应用价值。方法以2016-01-01-12-31在四川省人民医院健康管理中心进行团队健康体检的在职及离退休单位职工中CEA轻度升高者(5~10μg/L)为研究对象构建队列,随访截至2021-12-31,统计随访期间癌前病变及恶性肿瘤的发生情况,采用Cox比例风险回归模型分析CEA轻度升高体检者恶性肿瘤及癌前病变发病的危险因素。结果5149例CEA轻度升高体检者累积随访26012人年,中位随访时间5.05年。随访期间被确诊为癌前病变237例(4.60%),被确诊为恶性肿瘤205例(3.98%),阳性检出率为8.58%。女性癌前病变的检出率高于其恶性肿瘤检出率(χ^(2)=5.631,P=0.018),恶性肿瘤组的平均年龄高于癌前病变组,t=-2.281,P=0.023。多因素Cox比例风险回归模型分析结果显示,基线CEA[RR(95%CI)分别为1.179(1.01~1.364)和1.237(1.097~1.573)]、随访期间CEA持续升高[RR(95%CI)分别为1.724(1.151~2.591)和3.751(1.338~10.514)]是影响CEA轻度升高体检者恶性肿瘤及癌前病变发病的独立危险因素。结论健康体检人群中CEA轻度升高对恶性肿瘤及癌前病变的筛查具有重要意义。针对CEA轻度升高的体检者,动态随访观察是发现早期肿瘤的有效方法,包括首先进行CEA复查,复查仍偏高时进一步进行相关肿瘤早筛检查。

Objective To explore the application value of mildly increase of serum carcinoembryonic antigen(CEA)in tumor prediction of healthy physical examination people.Methods A cohort was constructed by taking those in-service and retired employees who were found a slight increase in CEA(5-10μg/L)as they performed team health examinations in the health management center of Sichuan Provincial People's Hospital from January 1,to December 31,2016 as the research subjects.The follow-up was conducted to December 31,2021,and the incidence of precancerous lesions and malignant tumors during the follow-up period was statistically analyzed.Cox proportional risk regression model was used to analyze the risk factors of the incidence of malignant tumors and precancerous lesions in those who had a slight increase in CEA.Results Totally 5149 patients with slight increase of CEA were followed up for 26012 person years,with a median follow-up time of 5.05 years.During the follow-up period,237 cases were diagnosed as precancerous lesions(4.60%),205 cases were diagnosed as malignant tumors(3.98%),and the positive detection rate was 8.58%.The detection rate of female precancerous lesions was significantly higher than that of malignant tumors(χ^(2)=5.631,P=0.018).The average age in malignant tumor group was older than that in precancerous lesions group(t=-2.281,P=0.023).Multivariate Cox proportional hazards regression model analysis showed that baseline CEA[RR(95%CI)were 1.179(1.01-1.364),1.237(1.097-1.573)] and continuous increase of CEA during follow-up[RR(95%CI)were 1.724(1.151-2.591),3.751(1.338-10.514)] were independent risk factors affecting the incidence of malignant tumors and precancerous lesions in patients with mild increase of CEA.Conclusions The slight increase of CEA in healthy people is of great significance for the screening of malignant tumors and precancerous lesions.For physical examinees with slightly elevated CEA,dynamic follow-up observation is an effective method to find early tumors,including CEA re-examination first,and further early screening of relevant tumors when the re-examination is still high.