门静脉血循环肿瘤细胞、C反应蛋白/清蛋白、糖类抗原199/糖类抗原50比值联合评估根治性胰腺癌切除术后生存情况的研究

Value of combined detection of portal vein blood CTCs,CAR,and CA199/CA50 ratio in assessing survival after radical resection for pancreatic cancer

目的:研究门静脉血循环肿瘤细胞(CTCs)、C反应蛋白/清蛋白(CAR)、糖类抗原199/糖类抗原50(CA199/CA50)比值联合评估根治性胰腺癌切除术后患者的生存情况。方法:选取我院2018年1月—2020年1月收治的83例接受胰腺癌根治术患者。检测患者门静脉血的CTCs、CAR、CA199/CA50水平,比较不同病理特征患者的CTCs、CAR、CA199/CA50水平。对患者随访2年,分析生存与死亡患者门静脉血CTCs、CAR、CA199/CA50水平,采用受试者工作特征曲线分析CTCs、CAR、CA199/CA50对患者术后生存的评估价值,并用Kaplan-Meier生存曲线分析CTCs、CAR、CA199CA50对肝癌患者的影响。结果:存在淋巴结转移、TNM分期Ⅲ期和低分化程度患者的门静脉血CTCs、CAR、CA199/CA50水平均高于不存在淋巴结转移、TNM分期为Ⅰ-Ⅱ期和中高分化程度的患者(P<0.05)。与死亡组患者相比,生存组患者门静脉血CTCs、CAR、CA199/CA50水平更低(P<0.05)。门静脉血CTCs、CAR、CA199/CA50对于根治性胰腺癌切除术患者预后评估的灵敏度分别为78.9%、78.8%和73.7%,特异度分别为90.6%、91.0%和91.2%,三者联合对根治性胰腺癌切除术患者预后评估的灵敏度为89.5%,特异度为93.7%,三者联合对于根治性胰腺癌切除术患者预后的灵敏度和特异度均高于各项单独检测。CTCs正常组(n=50)的生存率为86.00%,高于CTCs升高组(n=33)的63.63%;CAR正常组(n=47)的生存率为82.97%,高于CAR升高组(n=36)的69.44%;CA199/CA50正常组(n=53)的生存率为88.67%,高于CA199/CA50升高组(n=30)的56.66%,差异有统计学意义(P<0.05)。结论:门静脉血CTCs、CAR、CA199CA50比值联合评估根治性胰腺癌切除术后的生存价值较高,三者联合的灵敏度和特异性高于各项单独检测。

Objective To study the combined assessment of survival after radical pancreatic cancer resection by portal vein circulating tumor cells(CTCs),C-reactive protein/clear protein(CAR),and glycoantigen 199/glycoantigen 50(CA199/CA50)ratio.Methods Eighty-three patients admitted to our hospital from January 2018 to January 2020 who underwent radical pancreatic cancer resection were selected.The CTCs,CAR,and CA199/CA50 levels of patients'portal vein blood were detected,and the CTCs,CAR,and CA199/CA50 levels of different pathological features were compared;the patients were followed up for 2 years,and the CTCs,CAR,and CA199/CA50 levels of portal vein blood of the patients who survived and those who died were analyzed,and CTCs,CAR,and CA199/CA50 levels of the patients who survived and those who died were analyzed by using the working characteristic curves of the subjects,CA199/CA50 to assess the value of patients'postoperative survival,and Kaplan-Meier survival curves were used to analyze the effects of CTCs,CAR,CA199/CA50 on patients with hepatocellular carcinoma.Results The levels of portal blood CTCs,CAR,and CA199/CA50 were significantly higher in patients with the presence of lymph node metastasis,TNM stage Ⅲ,and low degree of differentiation than in patients without lymph node metastasis TNM stage Ⅰ-Ⅱ,and intermediate to high degree of differentiation(P<0.05).Surviving patients had lower levels of portal vein blood CTCs,CAR and CA199/CA50 compared with deceased patients(P<0.05).The sensitivity of portal vein blood CTCs,CAR,and CA199/CA50 for the prognostic assessment of patients undergoing resection for radical pancreatic cancer was 78.9%,78.8%and 73.7%,respectively,and the specificity was 90.6%,91.0%and 91.2%,respectively,and the combination of all three had a sensitivity of 89.5%and specificity of 93.7%for the prognostic assessment of patients undergoing resection for radical pancreatic cancer.The sensitivity and specificity of the combination of the three tests for the prognosis of patients undergoing radical pancreatic cancer resection were higher than those of the individual tests.86.00%of the survival rate in the CTCs normal group(n=50)was higher than that in the CTCs elevated group(n=33)(63.63%).82.97%of the survival rate in the CAR normal group(n=47)was higher than that in the CAR elevated group(n=36)(69.44%).The survival rate of the CA199/CA50 normal group(n=53)was 88.67%,higher than that of the CA199/CA50 elevated group(n=30)of 56.66%,which the difference was statistically significant(P<0.05).Conclusion The combined assessment of survival after radical pancreatic cancer resection by portal vein blood CTCs,CAR and CA199/CA50 ratio is of high value,and the sensitivity and specificity of the combination of the three is higher than that of each individual test.