Ki67、CEA、CA199及相关临床病理特征与转移性结直肠癌的生存预后分析

Analysis of the prognostic survival of Ki67,CEA,CA199 and relevant clinical path⁃ological features in metastatic colorectal cancer

目的分析Ki67、CEA、CA199及相关临床病理特征与转移性结直肠癌(metastatic colorectal cancer,mCRC)生存预后的关系。方法选择2017年3月至2022年3月温州市中心医院收治的131例mCRC患者为研究对象。收集并分析131例m CRC患者的临床资料,采用Kaplan-Meier法绘制生存曲线,Log-rank检验分析Ki67、CEA、CA199与生存预后的关系,Cox比例风险回归模型分析影响患者生存预后的因素。结果131例m CRC患者中,病理类型:腺癌128例(97.7%)、黏液腺癌3例(2.3%);肿瘤位置:左半结肠54例(41.2%)、右半结肠28例(21.4%)、直肠49例(37.4%);肿瘤分化程度:高分化5例(3.8%),中分化103例(78.6%),低分化23例(17.6%);83例(63.4%)接受手术治疗,48例(36.6%)不接受手术治疗;103例(78.6%)进行靶向治疗,28例(21.4%)未进行靶向治疗;7例(5.4%)进行免疫治疗:124例(94.6%)未进行免疫治疗;Ki67低表达21例(16.0%),高表达110例(84.0%);CEA阴性患者23例(17.6%),阳性患者108例(82.4%);CA199阴性患者35例(26.7%),阳性患者96例(73.3%)。单因素分析结果显示,肿瘤位置、手术治疗、靶向治疗、Ki67、CEA、CA199均与患者生存预后相关(均P<0.05)。生存分析结果显示,Ki67低表达、CEA阴性、CA199阴性的m CRC患者的OS均长于Ki67高表达、CEA阳性、CA199阳性的患者(均P<0.05)。多因素Cox比例风险回归模型分析结果显示,CEA阳性(P=0.033,HR=2.862,95%CI为1.090~8.071)、不接受靶向治疗(P=0.040,HR=0.466,95%CI为1.033~3.845)是mCRC患者生存时间的独立危险因素。结论靶向治疗对改善mCRC患者的生存预后具有重要作用,Ki67、CEA、CA199可能可以作为预测m CRC患者生存预后的评价指标,为临床改善患者的预后和指导治疗提供相关依据。

Objectives To analyze the relationship between Ki67,CEA,CA199,and relevant clinical pathological features and the prognostic survival of metastatic colorectal cancer(mCRC).Methods A total of 131 patients with mCRC who were admitted to Wenzhou Central Hospital from March 2017 to March 2022 were enrolled in this study.The clinical data of the patients were collected and analyzed.The Kaplan-Meier method was used to plot the survival curve,and the log-rank test was used to ana⁃lyze the relationship between Ki67,CEA,CA199,and prognostic survival.The Cox proportional hazards regression model was used to analyze the factors affecting patient survival prognosis.Results Among the 131 patients with mCRC,the pathological types were adenocarcinoma in 128 cases(97.7%)and mucinous adenocarcinoma in 3 cases(2.3%).The tumor locations were 54 cases(41.2%)in the left colon,28 cases(21.4%)in the right colon,and 49 cases(37.4%)in the rectum.The tumor differentia⁃tion degrees were high differentiation in 5 cases(3.8%),moderate differentiation in 103 cases(78.6%),and low differentiation in 23 cases(17.6%).Of these,83 cases received surgical treatment,48 cases(36.6%)did not receive surgical treatment;103 cases(78.6%)underwent targeted therapy,and 28 cases(21.4%)did not undergo targeted therapy;7 cases(5.4%)received immunothera⁃py,and 124 cases(94.6%)did not receive immunotherapy.Ki67 showed low expression in 21 cases(16.0%)and high expression in 110 cases(84.0%).CEA was negative in 23 patients(17.6%)and positive in 108 patients(82.4%).CA199 was negative in 35 patients(26.7%)and positive in 96 patients(73.3%).The results of univariate analysis showed that tumor location,surgical treat⁃ment,targeted therapy,Ki67,CEA,and CA199 were all correlated with patient survival prognosis(P<0.05).The survival analysis results showed that the overall survival(OS)of mCRC patients with low Ki67 expression,negative CEA,and negative CA199 was longer than that of patients with high Ki67 expression,positive CEA,and positive CA199(P<0.05).The results of the multivari⁃ate Cox proportional hazards regression model analysis showed that positive CEA(P=0.033,HR=2.862,95%CI 1.090-8.071)and no targeted therapy(P=0.040,HR=0.466,95%CI 1.033~3.845)were independent risk factors for the survival time of mCRC pa⁃tients.Conclusion Targeted therapy plays an important role in improving the survival prognosis of mCRC patients.Ki67,CEA,and CA199 may be used as evaluation indicators for predicting the survival prognosis of mCRC patients,providing relevant evi⁃dence for improving the prognosis and guiding treatment in clinical practice.