血清CEA及CA19-9在结直肠癌伴同时性肝转移的诊断价值

The diagnostic value of serum CEA and CA19-9 in colorectal cancer patients with synchronous liver metastasis

目的研究结直肠癌患者血清中CEA、CA19-9以及联合检测对肝转移的诊断效能。方法回顾性收集2015年1月1日至2019年4月1日期间由安徽医科大学第一附属医院收治的86例结直肠癌患者临床资料,按是否肝转移分为肝转移组和非转移组。通过卡方检验或独立样本t检验或非参数检验方法进行单因素分析,进一步将有统计学意义的因素纳入logistic多因素分析,并通过ROC曲线确定CEA、CA19-9的临界值及评估CEA、CA19-9和联合检测的诊断效能。结果单因素分析结果显示,患者性别、年龄、血便、乙肝、分化程度、肝功能指标、NLR、PLR表达水平与结直肠癌肝转移无相关关系(均P>0.05),而体重下降、原发灶位置、CEA、CA19-9与结直肠肝转移具有相关关系,差异有统计学意义(均P<0.01)。多因素分析表明,体重下降和CEA>5 ng/ml是结直肠癌肝转移的独立预测因素(均P<0.05)。通过绘制ROC曲线,得到:CEA和CA19-9的最佳临界值分别为8.6和16.86(敏感度:67.4%和63.0%,特异度:90.0%和80.0%)。CEA以及CEA联合CA19-9检测对结直肠癌肝转移的诊断效能较高(AUC=0.787,P=0.000;AUC=0.777,P=0.000)。结论 CEA和体重下降是结直肠癌肝转移的独立预测因素,单独CEA或者联合CA19-9检测对于结直肠癌肝转移的诊断效能较高,可作为临床实践的重要参考。

Objective To study the diagnostic efficacy of serum CEA and CA19-9 in colorectal cancer(CRC)patients with synchronous liver metastasis.Methods Clinical data of 86 CRC patients admitted to the First Affiliated Hospital of Anhui Medical University from January 1 st,2015 to April 1 st,2019 were retrospectively collected.The patients were divided into liver metastasis group and non-metastasis group according to whether they had liver metastasis or not.Univariate analysis was conducted by chi-square test,independent sample t test or non-parametric test,and the statistically significant factors were further included in logistic multivariate analysis,and the cutoff values of CEA and CA19-9 were determined by ROC curve,and the diagnostic efficacy of CEA,CA19-9 and CEA&CA19-9 tests was also evaluated.Results according to the results of univariate analysis,there was no correction between liver metastasis and gender,age,blood,hepatitis B virus,the degree of differentiation,liver function index,NLR,PLR in CRC patients(P>0.05).However,weight loss,the primary tumor location,CEA and CA19-9 were associated with liver metastasis,and the difference was statistically significant(P<0.01).Multivariate analysis results showed that weight loss and CEA>5 ng/ml were independent predictors of liver metastasis in CRC(P<0.05).The optimal critical values of CEA and CA19-9 were 8.6 and 16.86(sensitivity:67.4%and 63.0%,specificity:90.0%and 80.0%)respectively by ROC curve.CEA and CEA&CA19-9 tests have higher diagnostic efficacy in CRC with liver metastasis(AUC=0.787,P=0.000;AUC=0.777,P=0.000).Conclusion CEA and weight loss are independent predictors of liver metastasis in CRC,and CEA alone or CEA&19-9 tests has a higher diagnostic efficacy for liver metastasis in CRC patients,which could be used as an important reference for clinical practice.