胆管癌血清肿瘤标志物与病理特征的相关性分析

Correlation between serum tumor markers and pathological features in cholangiocarcinoma

目的探讨胆管癌(cholangiocarcinoma,CCA)患者病理特征和血清肿瘤标志物甲胎蛋白(alpha fetoprotein,AFP)、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)、癌胚抗原(carcinoembryonic antigen,CEA)和CA125之间的关系。方法对2012年10月至2020年5月在首都医科大学附属北京佑安医院经病理检查确诊的以胆管细胞来源为主的CCA患者359例进行回顾性研究,取患者空腹血清用电化学发光免疫法检测肿瘤标志物AFP、CA19-9、CEA和CA125水平。分析血清肿瘤标志物的表达与病理分型、病理分化程度、肿瘤直径、肿瘤位置、血管癌栓和转移路径等病理特征的关系。结果CCA患者AFP、CA19-9、CEA和CA125异常率分别为37.5%(116/309)、54.0(147/272)、27.4%(75/274)和38.5%(25/65)。肝细胞癌-胆管细胞癌混合癌患者(混合组)的AFP水平中位数高于单纯胆管细胞癌组患者(单纯组;7.87 ng/mL vs 4.05 ng/mL,P=0.030)。混合组高水平AFP者肿瘤均位于肝内且呈低分化。CA19-9异常在单纯组、有血管癌栓的患者和肿瘤直径≥5 cm的患者中更常见(均P<0.05),尤其高水平CA19-9(≥1000 U/mL)患者比例在单纯组高于混合组(15.1%vs 0.0%,P=0.012),其中单纯组高水平CA19-9者合并血管癌栓占60.6%,合并肿瘤直径≥5 cm占72.7%。CEA异常率在肿瘤位置为肝外、有血管癌栓、有淋巴结转移和有神经侵犯的患者中更常见(均P<0.05)。CA125异常率在有血管癌栓和肿瘤直径≥5 cm的患者中更常见(均P<0.05)。结论CCA患者病理分型、病理分化程度、肿瘤直径、肿瘤位置、血管淋巴结转移及神经侵犯等病理特征与血清肿瘤标志物AFP、CA19-9、CEA和CA125的表达密切相关。

Objective To analyse the correlation between serum tumor markers,including alpha fetoprotein(AFP),carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA)and CA125,and the pathological characteristics of cholangiocarcinoma(CCA)patients.Methods A retrospective study was conducted in 359 CCA patients confirmed by pathological examination,enrolled at Beijing YouAn Hospital,Capital Medical University,from October 2012 to May 2020.The levels of tumor markers including AFP,CA19-9,CEA and CA125 in fasting serum were detected by electrochemiluminescence immunoassay.The correlation between the tumor markers and pathological characteristics such as pathological type,pathological differentiation,tumor size,tumor location,vascular tumor thrombus and routes of metastasis was analyzed.Results The abnormal rates of AFP,CA19-9,CEA and CA125 in CCA patients were 37.5%(116/309),54.0(147/272),27.4%(75/274)and 38.5%(25/65),respectively.The median AFP level in combined hepatocellular-CCA(cHCC-CCA)patients was higher than that in patients with CCA alone(7.87 ng/mL vs 4.05 ng/mL,P=0.030).The tumors in cHCC-CCA patients with high level of AFP were all located in the liver and showed low differentiation.The abnormality of CA19-9 was higher in patients with CCA alone,vascular tumor thrombus and tumor diameter≥5 cm(all P<0.05).The proportion of patients with CA19-9 level≥1000 U/mL was higher in patients with CCA alone than that in cHCC-CCA patients(15.1%vs 0.0%,P=0.012).In patients with CCA alone and CA19-9 level≥1000 U/mL,60.6%of the patients were complicated with vascular tumor thrombus,and 72.7%of the patients had tumor diameters≥5 cm.The abnormal rate of CEA was higher in patients with extrahepatic tumors,vascular tumor thrombus,lymph node metastasis and peripheral nerve invasion(all P<0.05).The abnormal rate of CA125 was higher in patients with vascular tumor thrombus and tumor diameter≥5 cm(both P<0.05).Conclusions The expressions of serum tumor markers including AFP,CA19-9,CEA and CA125 were closely related to the pathological type,pathological differentiation,tumor size,tumor location,vascular lymph node metastasis and peripheral nerve invasion of CCA patients.