血清肿瘤标志物联合检测在结肠癌诊断和预后评估中的价值

The value of combined detection of serum tumor markers in the diagnosis and prognosis evaluation of colon cancer

目的探讨血清肿瘤标志物糖类抗原125(CA125)、癌胚抗原、糖类抗原199(CA19-9)联合检测在结肠癌诊断和预后评估中的价值。方法选取2017年1月至2018年6月在山东省日照市人民医院首次诊治的116例结肠癌患者作为观察组,另选取同期来医院诊疗的50例结肠良性病变患者作为对照组。检测和比较2组患者血清CA125、癌胚抗原、CA19-9水平。采用多因素Logistic回归方法分析结肠癌的影响因素。采用Kaplan-Meier法及Log-rank检验进行生存分析。以病理诊断为金标准,用四格表法统计计算单项及联合检查诊断结肠癌的价值。结果观察组血清CA125、癌胚抗原和CA19-9水平均高于对照组[(96±15)kU/L比(24±4)kU/L,(56.8±6.2)μg/L比(2.6±0.6)μg/L,(118±19)kU/L比(25±6)kU/L](t=23.551、62.560、34.712,均P<0.01)。观察组患者临床高分期(Ⅲ~Ⅳ期)、低分化、远处转移患者血清CA125、癌胚抗原、CA19-9水平均明显高于临床低分期(Ⅰ~Ⅱ期)、高分化/中分化、无远处转移患者血清水平(均P<0.001)。多因素Logistic回归分析结果显示血清CA125、癌胚抗原、CA19-9水平升高均是发生结肠癌的独立危险因素。随访5年,血清CA125、癌胚抗原、CA19-9高表达组5年无事件生存率均明显低于低表达组(均P<0.01)。血清CA125、癌胚抗原、CA19-9三项联合检测诊断结肠癌的敏感度、准确度、阴性预测值均明显高于单项及两项组合检测(均P<0.05)。结论血清CA125、癌胚抗原、CA19-9均可作为诊断结肠癌的生物学指标,三项联合检测明显提高诊断结肠癌的价值。

Objective To investigate the value of combined detection of serum tumor markers carbohydrate antigen 125(CA125),carcinoembryonic antigen(CEA)and carbohydrate antigen 199(CA19-9)in the diagnosis and prognosis evaluation of colon cancer.Methods A total of 116 patients with colon cancer who were first diagnosed and treated in People′s Hospital of Rizhao,Shandong Province from January 2017 to June 2018 were selected as the observation group,and 50 patients with benign colon lesions who came to the hospital for diagnosis and treatment during the same period were selected as the control group.The serum levels of CA125,CEA and CA19-9 were detected and compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of colon cancer.Kaplan-Meier method and Log-rank test were used for survival analysis.With pathological diagnosis as the gold standard,the diagnostic value of single and combined examination for colon cancer was calculated by four-fold table method.Results The levels of serum CA125,CEA and CA19-9 in the observation group were higher than those in the control group[(96±15)kU/L vs(24±4)kU/L,(56.8±6.2)μg/L vs(2.6±0.6)μg/L,(118±19)kU/L vs(25±6)kU/L](t=23.551,62.560,34.712,all P<0.01).The serum levels of CA125,CEA and CA19-9 in patients with high clinical stage(Ⅲ-Ⅳ),low differentiation and distant metastasis in the observation group were significantly higher than those in patients with low clinical stage(Ⅰ-Ⅱ),high differentiation/moderate differentiation and no distant metastasis(all P<0.001).Multivariate Logistic regression analysis showed that elevated serum levels of CA125,CEA and CA19-9 were independent risk factors for colon cancer.After 5 years of follow-up,the 5-year event-free survival rate of the high expression group of serum CA125,CEA and CA19-9 was significantly lower than that of the low expression group(all P<0.01).The sensitivity,accuracy and negative predictive value of combined detection of serum CA125,CEA and CA19-9 in the diagnosis of colon cancer were significantly higher than those of single detection and the combination of two detection(all P<0.05).Conclusion Serum CA125,CEA and CA19-9 can be used as biological indicators for the diagnosis of colon cancer,and the combined detection of the three can significantly improve the diagnostic value of colon cancer.