晚期胃癌放化疗前后CEA、CA-199变化及意义

Changes and significance of CEA and CA-199 before and after radiotherapy and chemotherapy for advanced gastric cancer

目的探讨局部晚期胃癌患者放化疗前后癌胚抗原(CEA)及糖类抗原-199(CA-199)水平变化,并分析其变化意义。方法选择2003年7月~2011年6月在我院接受放化疗治疗的局部晚期胃癌患者38例,再随机选取同期进行体检健康者38例。分别测量胃癌患者放化疗前后以及健康体检者的CEA、CA-199水平,所有参与者均在清晨空腹取静脉血采用电化学发光免疫法检测,并通过CEA、CA-199水平指标诊断胃癌。结果晚期胃癌患者CEA、CA-199水平高于健康体检者。在放化疗后CEA、CA-199水平明显降低,显著低于放疗前。CEA检测的准确度、特异性以及敏感度达到91.67%、96.67%和86.67%,CA-199的依次为76.67%、83.33%、76.00%。并且所有患者在放化疗后总阳性率降低至42.11%(16/38)。其中CEA降低的患者阳性率更低,3年后总生存率更高。CA-199降低的患者其阳性率更低,无病生存率以及3年后总生存率均更高,差异均有统计学意义(均P<0.05)。结论局部晚期胃癌患者在放化疗治疗后CEA、CA-199水平明显下降,并且通过CEA、CA-199水平诊断局部晚期胃癌的准确度高。在对放疗后CEA、CA-199水平升高,预后不良的可能性明显升高。并且治疗后CEA、CA-199水平与治疗患者阳性的比例、无病生存率及3年后生存率呈正相关性。

Objective To explore the changes of carcino-embryonic antigen(CEA) and carbohydrate antigen-199(CA-199) before and after radiotherapy and chemotherapy in patients with local advanced gastric cancer, and to analyze the significance of the changes. Methods A total of 38 patients with local advanced gastric cancer who received radiotherapy and chemotherapy in our hospital from July 2003 to June 2011 were selected, and another 38 healthy subjects who received physical examination in our hospital at the same period of time were randomly selected. CEA and CA-199 levels of patients with gastric cancer before and after radiotherapy and chemotherapy, as well as the levels of healthy subjects were measured respectively. Venous blood samples were collected for all subjects at early morning under fasting condition, and the blood samples were tested by electro-chemiluminescence before gastric cancer was diagnosed by levels of CEA and CA-199 indices. Results The levels of CEA and CA-199 in patients with advanced gastric cancer were higher than those in the healthy subjects. After radiotherapy and chemotherapy, levels of CEA and CA-199 significantly reduced, and significantly lower than those before radiotherapy and chemotherapy. Accuracy, specificity and sensitivity of CEA were 91.67%, 96.67% and 86.67% respectively, and accuracy, specificity and sensitivity of CA-199 were 76.67%, 83.33% and 76.00% respectively. Total positive rate for all patients after radiotherapy and chemother-apy reduced to 42.11%(16/38). Total positive rate for patients with decreased CEA was lower, and 3-year total survival rate was higher. The total positive rate for patients with decreased CA-199 was lower, and the disease free survival rate and 2-year total survival rate were both higher, the differences were statistically significant( P<0.05 for both). Conclusion The levels of CEA and CA-199 significantly reduce after radiotherapy and chemotherapy for patients with local advanced gastric cancer, and the accuracy of CEA and CA-199 for diagnosing local advanced gastric cancer is high.The possibilities of poor prognosis significantly rise when levels of CEA and CA-199 after radiotherapy increase. The levels of CEA and CA-199 after the treatment are positively correlated with the proportion of positive patients, disease free survival rate and 3-year survival rate.