术前血清CA19-9和CEA联合升高与胆囊癌术后生存期的相关性研究
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摘要
目的评估联合术前血清标志物糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)和癌胚抗原(carcino-embryonic antigen,CEA)的升高对胆囊癌患者术后生存期的预测价值。方法回顾性分析接受胆囊癌切除术的107例胆囊癌患者的术前CA19-9和CEA水平及术后生存期。分别以CA19-9≥37 U/mL和CEA≥5 mg/L为CA19-19和CEA标志物水平异常升高,将患者分为三组:这2种标志物水平均正常者为A组(n=40),仅1种异常升高者为B组(n=42),2种均异常升高者为C组(n=25)。通过Kaplan-Meier曲线评估患者术后生存差异,以单因素和多因素Cox回归分析判断影响胆囊癌患者术后生存期的独立影响因素,并通过受试者工作(receiver operating characteristic,ROC)曲线判断肿瘤标志物对胆囊癌患者预后的预测价值。结果 C组术后1、3和5年总生存率均低于其他两组,中位总生存期短于A组和B组(5个月vs 26个月、12个月,P<0.05)。C组RO切除率均低于A组和B组(45.0%vs 86.0%、73.0%,P<0.05)。联合CA19-9和CEA的升高是预测胆囊癌患者不良预后的危险因素(P<0.05)。联合CA19-9和CEA对患者预后的预测价值高于单独使用CA19-9或CEA。结论术前血清CA19-9和CEA同时升高与胆囊癌患者术后生存率降低相关。
Objective To evaluate the preoperative serum carbohydrate antigen 19-9(CA19-9) and carcino-embryonic antigen(CEA) levels in predicting postoperative survival in patients with gallbladder cancer(GBC). Methods The preoperative CA19-9 and CEA levels and the postoperative survival of 107 GBC patients who underwent cholecystectomy were retrospectively analyzed. CA19-9≥37 U/mL and CEA≥5 mg/L were defined as abnormal elevation. The patients were divided into three groups: group A(n=40) with both markers normal, group B(n=42) with only one marker abnormally elevated, and group C(n=25) with both markers abnormally elevated. Kaplan-Meier curves were used to compare the differences in postoperative survival. Univariate and multivariate Cox regression analyses were applied to determine the independent factors affecting the postoperative survival of GBC patients, and the receiver operating characteristic(ROC) curve was used to determine the predictive value of tumor markers for GBC patients. Results The overall 1-, 3-and 5-year survival rates of group C were lower than those of the other two groups. The median overall survival length of group C was also shorter than those of group A and group B(5 months vs 26 months and 12 months, P<0.05). In addition, the R0 resection rate of group C was lower than those of group A and group B(45.0% vs 86.0% and 73.0%, P<0.05). Finally, the elevation of both CA19-9 and CEA was a risk factor for poor prognosis in GBC patients(P<0.05). The prognostic value of CA19-9 combined with CEA was higher than that of CA19-9 or CEA alone. Conclusion The preoperative elevation of both serum CA19-9 and CEA was associated with decreased survival in patients with gallbladder cancer.
Objective To evaluate the preoperative serum carbohydrate antigen 19-9(CA19-9) and carcino-embryonic antigen(CEA) levels in predicting postoperative survival in patients with gallbladder cancer(GBC). Methods The preoperative CA19-9 and CEA levels and the postoperative survival of 107 GBC patients who underwent cholecystectomy were retrospectively analyzed. CA19-9≥37 U/mL and CEA≥5 mg/L were defined as abnormal elevation. The patients were divided into three groups: group A(n=40) with both markers normal, group B(n=42) with only one marker abnormally elevated, and group C(n=25) with both markers abnormally elevated. Kaplan-Meier curves were used to compare the differences in postoperative survival. Univariate and multivariate Cox regression analyses were applied to determine the independent factors affecting the postoperative survival of GBC patients, and the receiver operating characteristic(ROC) curve was used to determine the predictive value of tumor markers for GBC patients. Results The overall 1-, 3-and 5-year survival rates of group C were lower than those of the other two groups. The median overall survival length of group C was also shorter than those of group A and group B(5 months vs 26 months and 12 months, P<0.05). In addition, the R0 resection rate of group C was lower than those of group A and group B(45.0% vs 86.0% and 73.0%, P<0.05). Finally, the elevation of both CA19-9 and CEA was a risk factor for poor prognosis in GBC patients(P<0.05). The prognostic value of CA19-9 combined with CEA was higher than that of CA19-9 or CEA alone. Conclusion The preoperative elevation of both serum CA19-9 and CEA was associated with decreased survival in patients with gallbladder cancer.
引文
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[2] 蒙秀坚,陈秀勤,陆爱英,等.血清肿瘤标志物CA19-9的临床应用研究[J].国际检验医学杂志,2014,35(12):1566-1567.
[3] Grunnet M,Mau-S?rensen M.Serum tumor markers in bile duct cancer--a review[J].Biomarkers,2014,19(6):437-443.
[4] Zhang Y,Yang J,Li H,et al.Tumor markers CA19-9,CA242 and CEA in the diagnosis of pancreatic cancer:a meta-analysis[J].Int J Clin Exp Med,2015,8(7):11683-11691.
[5] 宋文渊,吴雷,赵红岩,等.外周血内CA19-9、CA242及CEA对胰腺癌诊断及病理分期评估的价值[J].实用肿瘤杂志,2017,32(1):52-56.
[6] 耿智敏,王林,陈晨,等.438例胆囊癌外科治疗及预后因素分析[J].中华消化外科杂志,2016,15(4):346-352.
[7] 高磊,谌松霖,王光霞.超声联合CA19-9及CEA检测对胆囊癌早期诊断准确性的影响[J].中国中西医结合外科杂志,2017,23(3):239-242.
[8] Nishikawa H,Nishijima N,Enomoto H,et al.Predictive factors in patients with hepatocellular carcinoma receiving sorafenib therapy using time-dependent receiver operating characteristic analysis[J].J Cancer,2017,8(3):378-387.
[9] Tada T,何丽丽,李婉玉.HBcrAg为肝细胞癌发展的预测因子[J].临床肝胆病杂志,2016,32(7):1405.
[10] Groot Koerkamp B,Fong Y.Outcomes in biliary malignancy[J].J Surg Oncol,2014,110(5):585-591.
[11] Singh SK,Talwar R,Kannan N,et al.Aggressive surgical approach for gallbladder cancer:a single-center experience from Northern India[J].J Gastrointest Cancer,2015,46(4):399-407.
[12] Sharma A,Dwary AD,Mohanti BK,et al.Best supportive care compared with chemotherapy for unresectable gallbladder cancer:a randomized controlled study[J].J Clin Oncol,2010,28(30):4581-4586.
[13] 黄勇,刘峰,姜斌.替吉奥或顺铂联合吉西他滨治疗进展期胆囊癌临床观察[J].中华肿瘤防治杂志,2015,22(14):1134-1137.
[14] 孟强劳,王林,耿智敏.进展期胆囊癌新辅助化疗研究进展[J].中华肝胆外科杂志,2017,23(11):789-792.
[15] De AX,Losada H,Mora J,et al.Neoadjuvant chemoradiotherapy in gallbladder cancer[J].Rev Med Chi,2004,132(1):51-57.
[16] Agrawal S,Mohan L,Neyaz Z,et al.Radiological downstaging with neoadjuvant therapy in unresectable gall bladder cancers[J].Asian Pac J Cancer Prev,2015,17(4):2137-2140.
[17] Selvakumar VP,Zaidi S,Pande P,et al.Resection after neoadjuvant chemotherapy in advanced carcinoma of the gallbladder:a retrospective study[J].Indian J Surg Oncol,2015,6(1):16-19.