苑琴,强黎明,秦金玉
YUAN Qin,QIANG Liming,QIN Jinyu

• 1:四川大学华西广安医院消化内科

摘要(Abstract)：

目的 探讨血清甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)水平对Ⅲ期结直肠癌(CRC)复发或转移的预测价值。方法 100例行根治术治疗Ⅲ期CRC患者术后随访1年，根据有无复发转移分为复发转移组(n=16)和无复发转移组(n=84)，收集2组患者年龄、性别，肿瘤组织学类型、部位、直径、分化程度、浸润深度、侵犯部位、肠梗阻和穿孔、术后辅助化疗情况，比较2组患者入院后第1天血清AFP、CEA、CA19-9水平;采用logistic分析影响Ⅲ期CRC复发转移的因素，采用ROC曲线下面积(AUC)分析3项指标水平对Ⅲ期CRC术后复发转移的预测价值，采用pearson分析血清AFP水平与血清CEA、CA19-9水平的相关性。结果 复发转移组Ⅲ期CRC患者血清AFP、CEA、CA19-9水平高于未复发转移组，肿瘤组织分化程度低于未复发转移组，差异有统计学意义(P <0.05); Logistic多因素分析显示，肿瘤分化程度及血清AFP、CEA、CA19-9水平为Ⅲ期CRC复发转移的独立危险因素(P <0.05); ROC曲线分析显示，血清AFP、CEA、CA19-9水平联合预测Ⅲ期CRC复发转移的敏感度为96.40%,AUC为0.906，高于3项指标的单独检测(P <0.05); pearson分析显示，血清AFP水平与CEA、CA19-9水平呈正相关(P <0.05)。结论 Ⅲ期CRC复发转移患者血清AFP、CEA、CA19-9水平呈高表达，3项指标联合检测对Ⅲ期CRC复发转移的预测价值较高，血清AFP水平与CEA、CA19-9水平相关。
Objective To investigate the predictive value of serum alpha-fetoprotein (AFP),carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels for recurrence or metastasis of stageⅢcolorectal cancer (CRC).Methods 100 patients with stageⅢCRC who underwent radical surgery were selected as research subjects.All were followed up for 1 year after surgery.According to the presence or absence of recurrence and metastasis,the patients were divided into recurrence and metastasis group (n=16) and non-recurrence and metastasis group (n=84).Clinical data of both groups was collected (age,gender,histological types of tumor,location,diameter,degree of differentiation,depth of infiltration,location of invasion,intestinal obstruction and puncture,post-operation adjunctive chemotherapy).Serum AFP,CEA,and CA19-9 levels were compared one day after all patients were admitted to hospital.Logistic assay was adopted to analyze factors affecting recurrence and metastasis of stageⅢCRC.Area under the curve (AUC) of ROC curve was used to analyze the predictive value of the three indicators for post-operation recurrence and metastasis of stageⅢCRC.Pearson was used to analyze the correlation between AFP level and CEA level,CA19-9 level.Results Serum AFP,CEA,and CA19-9 levels of the recurrence and metastasis group were higher than those of the non-recurrence and metastasis group;the differentiation degree of recurrence and metastasis group was lower than that of the non-recurrence and metastasis group,differences were statistically significant (P<0.05).Multivariate logistic regression analysis showed that differentiation degree,serum AFP,CEA,and CA19-9 levels were independent risk factors for recurrence and metastasis of stageⅢCRC (P<0.05).ROC curve analysis showed that the sensitivity of combined prediction with serum AFP,CEA,and CA19-9 levels for recurrence and metastasis of stageⅢCRC was 96.40%,and the AUC was 0.906,which were higher than those of single index detection (P<0.05).Pearson analysis showed that serum AFP level was positively correlated with CEA and CA19-9 levels (P<0.05).Conclusion Serum AFP,CEA,and CA19-9 levels show high expression in patients with recurrence and metastasis of stageⅢcolorectal cancer.Combined three indexes detection will be helpful for predicting recurrence and metastasis of stageⅢcolorectal cancer.Serum AFP level is related to CEA and CA19-9 levels.

关键词(KeyWords)： 结直肠癌;复发或转移;甲胎蛋白;癌胚抗原;糖类抗原19-9;预测价值;相关性
colorectal cancer;recurrence or metastasis;alpha-fetoprotein(AFP);carcinoembryonic antigen(CEA);carbohydrate antigen 19-9(CA19-9);predictive value;correlation

Abstract:

Keywords:

基金项目(Foundation): 四川省卫生和计划生育委员会科研课题(18PJ394)

作者(Author): 苑琴,强黎明,秦金玉
YUAN Qin,QIANG Liming,QIN Jinyu

DOI: 10.19367/j.cnki.2096-8388.2023.02.010

参考文献(References)：

• [1]张洋，吴慧丽．不同方案对老年晚期结肠癌血清CEA,AFP,CA19-9,TK1水平及生存周期影响的对比[J]．中国医院药学杂志，2019,11(3):269-273．
• [2]中华人民共和国国家卫生健康委员会．中国结直肠癌诊疗规范(2020版)[J]．中华消化外科杂志，2020(8):563-588．
• [3]张成熙，李启刚．围术期CEA及CA19-9检测水平对结直肠癌术前分期及术后预后的影响[J]．检验医学与临床，2018,15(24):3698-3701,3706．
• [4]毛海波，朱国栋，方润娅，等．血管生成素-2、血管内皮生长因子、糖类抗原199及癌胚抗原对结肠癌诊断和复发转移的预测价值[J]．实用医学杂志，2019,35(3):428-432．
• [5]潘莉娟，杨静，董剑，等．术前血清CEA,CA19-9,CA50,AFP,TPS检测在结直肠癌肝转移中的预测价值[J]．国际检验医学杂志，2020,41(8):923-926．
• [6]ZHAI H,HUANG J,YANG C,et al.Serum CEA and CA19-9 levels are associated with the presence and severity of colorectal neoplasia[J].Clinical Laboratory,2018,64(3):351-356．
• [7]顾晋，汪建平，孙燕，等．中国结直肠癌诊疗规范(2017年版)[J]．中华外科杂志，2018,12 (1):3-23．
• [8]JI Q,CAI G,LIU X,et al.MALAT1 regulates the transcriptional and translational levels of proto-oncogene RUNX2 in colorectal cancer metastasis[J].Cell Death Disease,2019,10(6):378．
• [9]TAKAMARU H,SAITO Y,SEKIGUCHI M,et al.Endoscopic resection before surgery does not affect the recurrence rate in patients with high-risk t1 colorectal cancer[J].Clinical and Translational Gastroenterology,2021,12(4):e00336．
• [10]王奇龙，陈南征，吕铁升，等．血清CEA,CA19-9,CA242对结直肠癌转移及预后的评估价值[J]．解放军医药杂志，2020,32(6):35-39．
• [11]付裕，鲁稳柱，李鸿鹏，等．结直肠癌术后血清CTCs,CA125,CEA及CA19-9水平与复发或转移的相关性研究[J]．中国煤炭工业医学杂志，2020,23(2):143-148．
• [12]张刘平，许政文，张兴，等．血清mi R-335-5p,CEA,CA19-9水平对结肠癌腹腔镜术后复发转移的预测价值[J]．山东医药，2021,61(10):26-30．
• [13]罗炜，马贵亮，于璐，等．血清CEA,CA19-9联合ALP预测结直肠癌肝转移的价值[J]．中国现代普通外科进展，2020,23(4):326-328,331．
• [14]孙国钢，宋新江．转化生长因子-β1，缺氧诱导因子-1α，血管内皮生长因子，癌胚抗原，糖类抗原199在结直肠癌根治术后复发转移中的预测价值[J]．中国医师杂志，2020,22(12):1888-1892．
• [15]雷雨广，张伟丽，陈超，等．si RNA敲减缺氧诱导因子1α表达对口腔鳞癌细胞活力及癌胚抗原相关细胞黏附分子1表达的影响[J]．中国病理生理杂志，2018,34(10):1736-1741．
• [16]姜雅聪，张旭初，王剑杰，等．血清肿瘤标志物测定联合应用对结直肠癌术后复发与转移探测的临床诊断价值[J]．标记免疫分析与临床，2021,28(7):1106-1109．
• [17]赵晓朋，赵猛，任丽，等．术前血清CEA,CA19-9,CA72-4联合检测对Ⅰ~Ⅲ期结直肠癌手术患者预后的预测价值[J]．山东医药，2019,59(34):66-69．
• [18]林雪丹，杨天兴，陶志华，等．癌胚抗原和糖类抗原19-9对Ⅱ~Ⅲ期结肠癌复发的预测价值[J]．中国癌症杂志，2018,28(11):32-37．
• [19]XU W,HE Y,WANG Y,et al.Risk factors and risk prediction models for colorectal cancer metastasis and recurrence:an umbrella review of systematic reviews and meta-analyses of observational studies[J].BMC Med,2020,118(1):172．
• [20]SASAKI T,SHIGETA K,OKABAYASHI K,et al.Horizontal spread of pericolic lymph node metastasis as a prognostic factor for recurrence in StageⅢcolorectal cancer[J].Colorectal Dis,2021,23(6):1370-1378.

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