血清糖类抗原19-9、糖类抗原242、趋化因子20联合预测结肠癌术后复发转移的价值

Predictive value of serum carbohydrate antigen 19-9,carbohydrate antigen 242,and chemokine 20 in combination for postoperative recurrence and metastasis of colon cancer

目的分析血清糖类抗原19-9(CA19-9)、糖类抗原242(CA242)、趋化因子20(CCL20)联合对结肠癌术后复发转移的预测价值。方法选择2019年3月至2021年12月本院收治的结肠癌患者112例, 根据随访记录分为复发转移组(34例)和未复发转移组(78例), 酶联免疫吸附法(ELISA)检测血清CA19-9、CA242、CCL20表达水平;采用多因素Logistic回归分析结肠癌患者术后复发转移的影响因素;绘制受试者工作特征(ROC)曲线分析血清CA19-9、CA242、CCL20联合对结肠癌术后复发转移的预测价值;采用Pearson法分析血清CA19-9、CA242、CCL20之间及其与肿瘤标志物的相关性。结果与未复发转移组[(15.32±1.55) U/ml、(6.32±0.92) U/ml、(95.21±10.32) pg/ml]比较, 复发转移组的结肠癌患者的血清CA19-9[(19.25±2.36) U/ml]、CA242[(8.65±1.02) U/ml]、CCL20水平[(112.65±12.38) pg/ml]均显著升高(t=10.444、11.921、7.730, P<0.05);且两组患者的肿瘤直径、分化程度、TNM分期以及相关肿瘤标志物[血管内皮生长因子(VEGF)、癌胚抗原(CEA)、缺氧诱导因子-1α(HIF-1α)]之间差异有统计学意义(χ^(2)=3.973、5.185, t=2.902、20.328, P<0.05);TNM分期Ⅱ期、HIF-1α、CA19-9、CA242、CCL20水平均为影响结肠癌患者术后复发转移的危险因素[OR=1.325、1.259、1.559、1.452, 95%CI=1.047~1.676、1.010~1.569、1.122~2.167、1.049~2.010, P<0.05);ROC曲线结果显示, CA19-9、CA242、CCL20以及联合预测结肠癌术后复发转移的AUC为0.837、0.850、0.855、0.940, 联合预测显著优于CA19-9(Z=2.280, P<0.05)、CA242(Z=2.110, P<0.05)、CCL20(Z=3.020, P<0.01)单独预测;血清CA19-9、CA242、CCL20之间两两呈正相关, 三者与VEGF、CEA以及HIF-1α之间均呈正相关(r=0.402、0.534, P<0.05)。结论在结肠癌术后复发转移患者中, 血清CA19-9、CA242、CCL20水平显著升高, 均为影响结肠癌患者术后复发转移的危险因素, 三者联合检测有助于预测结肠癌术后复发转移。

Objective eTo analyze the predictive value of serum carbohydrate antigen 19-9(CA19-9),carbohydrate antigen 242(CA242),and chemokine 20(CCL20)in combination for postopera-tive recurrence and metastasis of colon cancer.Methods A total of 112 colon cancer patients admitted to our hospital from September 2019 to December 2021 were collected and divided into a recurrence group and metastasis group(n=34)and non-recurrence and non-metastasis group(n=78)based on follow-up re-cords.Enzyme linked immunosorbent assay(ELISA)was applied to detect the expression levels of serum CA19-9,CA242,and CCL20.Multivariate Logistic regression was applied to analyze the influencing fac-tors of postoperative recurrence and metastasis in colon cancer patients.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of serum CA19-9,CA242,and CCL20 in combi-nation for postoperative recurrence and metastasis of colon cancer.Pearson method was applied to analyze the correlation between serum CA19-9,CA242,CCL20 and tumor markers.ResulstsCompared with the non-recurrence and non-metastasis group[(15.32±1.55)U/ml,(6.32±0.92)U/ml,(95.21±10.32)pg/ml],the serum levels of CA19-9[(19.25±2.36)U/ml],CA242[(8.65±1.02)U/ml],and CCL20[(112.65±12.38)pg/ml]in colon cancer patients in the recurrence and metastasis group were obviously increased(t=10.444,11.921,7.730,P<0.05).There were statistically significant differences in tumor diameter,differentiation degree,TNM staging,and related tumor markers[vascular endothelial growth factor(VEGF),carcinoembryonic antigen(CEA),and hypoxia inducible factor-lα(HIF-1α)]between the two groups(X^(2)=3.973,5.185,t=2.902,20.328,P<0.05).TNM stage II,HIF-1α,CA19-9,CA242,and CCL20 levels were all risk factors for postoperative recurrence and metastasis in colon cancer patients[0R=1.325,1.259,1.559.1.452,95%CI=1.047-1.676,1.010-1.569.1.122-2.167,1.049-2.010,P<0.05].ROC curve results showed that the AUC of CA19-9,CA242,CCL2O,and their combined prediction for postoperative recurrence and metastasis of colon cancer was 0.837,0.850,0.855,and 0.940,which was obviously better than the individual prediction of CA19-9(Z=2.280,P<0.05),CA242(Z=2.110,P<0.05),and CCL20(Z=3.020,P<0.01).There was a pairwise positive correlation between serum CA19-9,CA242,and CCL20,and they were also positively correlated with VEGF,CEA,and HIF-1α(r=0.402,0.534,P<0.05).Conclusion In patients with postoperative recurrence and metastasis of colon cancer,serum levels of CA19-9,CA242,and CCL20 obviously increase,all of which are risk factors affecting postoperative recurrence and metastasis of colon cancer.The combined detection of three factors helps predict postoperative recurrence and metastasis of colon cancer.