早期胃癌患者化疗前后血清AFP、CEA、CA19-9、CA125水平变化及其对淋巴结转移的预测价值

Changes of serum AFP,CEA,CA19-9,CA125 levels before and after chemotherapy in patients with early gastric cancer and their predictive value for lymph node metastasis

目的观察早期胃癌患者化疗前后血清甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原125(CA125)表达水平的变化,并探讨其对患者淋巴结转移的预测价值。方法回顾性分析2020年12月至2022年11月西安医学院附属宝鸡医院收治的56例早期胃癌患者的临床资料,所有患者均接受化疗,分析患者化疗前、化疗后(化疗三期后)血清AFP、CEA、CA19-9、CA125水平的变化情况;按患者是否有淋巴结转移分为转移组9例和未转移组47例,采用多因素Logistic回归分析法分析胃癌患者淋巴结转移的影响因素;绘制受试者工作特征曲线(ROC)计算曲线下面积(AUC),评估血清AFP、CEA、CA19-9、CA125对淋巴结转移的预测价值。结果化疗后,患者的血清AFP、CEA、CA19-9、CA125水平分别为(9.28±2.27)ng/mL、(13.05±0.15)ng/mL、(82.32±8.06)U/mL、(76.08±7.32)U/mL,明显低于化疗前的(15.76±2.37)ng/mL、(35.25±2.27)ng/mL、(105.45±12.18)U/mL、(91.28±10.27)U/mL,差异均有统计学意义(P<0.05);转移组和未转移组在术前病灶大小、中性粒细胞-淋巴细胞比值、AFP、CEA、CA19-9、CA125水平方面比较差异均有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,术前病灶大小、中性粒细胞-淋巴细胞比值、AFP、PSA、CA19-9、CA125等指标升高是淋巴结转移的危险因素(P<0.05);经ROC分析结果显示,血清AFP、CEA、CA19-9、CA125预测早期胃癌患者发生淋巴结转移的AUC分别为0.908、0.836、0.853、0.845,其敏感度为84.6%、75.6%、84.6%、76.9%,各指标联合预测早期胃癌患者发生淋巴结转移的AUC为0.913,其敏感度、特异性分别为92.3%、80.3%。结论早期胃癌患者的血清AFP、CEA、CA19-9、CA125水平在化疗后均显著降低,其对早期胃癌发生淋巴结转移具有较好的预测价值。

Objective To observe the changes of serum alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),and carbohydrate antigen 125(CA125)before and after chemotherapy in patients with early gastric cancer,and to explore their predictive value for lymph node metastasis.Methods The clini-cal data of 56 patients with early gastric cancer admitted to Baoji Hospital Affiliated to Xi'an Medical University from December 2020 to November 2022 were retrospectively analyzed.All patients received chemotherapy.The changes of serum AFP,CEA,CA19-9,and CA125 levels were analyzed before and after chemotherapy(after the third stage of che-motherapy).The patients were divided into metastatic group(9 cases)and non-metastatic group(47 cases)according to whether they had lymph node metastasis.Multivariate Logistic regression analysis was performed to analyze the influ-encing factors of lymph node metastasis in gastric cancer patients.Receiver operating characteristic curve(ROC)was plotted to calculate area under the curve(AUC)to evaluate the predictive value of serum AFP,CEA,CA19-9 and CA125 in lymph node metastasis.Results Serum AFP,CEA,CA19-9,and CA125 levels of patients after chemothera-py were(9.28±2.27)ng/mL,(13.05±0.15)ng/mL,(82.32±8.06)U/mL,(76.08±7.32)U/mL,respectively,significantly lower than(15.76±2.37)ng/mL,(35.25±2.27)ng/mL,(105.45±12.18)U/mL,(91.28±10.27)U/mL before chemotherapy(P<0.05).There were statistically significant differences in preoperative lesion size,neutrophil-lymphocyte ratio,AFP,CEA,CA19-9,and CA125 between the metastatic group and the non-metastatic group(P<0.05).Multivariate Logistic regression analysis showed that preoperative lesion size,neutrophil-lymphocyte ratio,AFP,PSA,CA19-9,CA125 were the risk factors for lymph node metastasis(P<0.05).ROC curve analysis showed that the AUC of serum AFP,CEA,CA19-9,and CA125 to predict lymph node metastasis in patients with early gastric cancer were 0.908,0.836,0.853,and 0.845,with the sensitivity of 84.6%,75.6%,84.6%,and 76.9%,and the AUC of combined detection of the indexes for predicting lymph node metastasis in patients with early gastric cancer was 0.913,with the sensitivity and specificity of 92.3%and 80.3%.Conclusion Serum levels of AFP,CEA,CA19-9,and CA125 in patients with early gastric cancer were significantly reduced after chemotherapy,which had good predictive value for lymph node metastasis in early gastric cancer.