血清肿瘤标志物癌胚抗原和糖类抗原在胃癌腹膜转移中的诊断价值
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摘要
目的探讨血清肿瘤标志物癌胚抗原和糖类抗原在胃癌腹膜转移中的诊断价值,为胃癌腹膜转移的诊断提供理论依据。方法纳入2014年6月～2017年6月于乐山市人民医院肿瘤科诊治的68例胃癌患者,根据是否发生腹膜转移分为转移组(20例)与非转移组(48例);手术或化疗前采用全自动免疫分析仪检测血清肿瘤标志物癌胚抗原(Carcinoembryonic antigen,CEA)、糖类抗原CA724、CA242、CA211、CA19-9、CA125水平,比较两组各检测指标血清水平、阳性率。进行Logistic回归分析,绘制受试者特征ROC曲线,比较联合检测以及各指标单独检测的诊断效能。结果转移组血清CEA、CA724、CA242、CA211、CA19-9、CA125水平均显著高于非转移组,差异均有统计学意义(P<0.05);转移组血清CA724、CA125、CA211阳性率显著高于非转移组,差异均有统计学意义(P<0.05),血清CEA、CA242、CA19-9阳性率差异无统计学意义(P>0.05);CA724、CA125、CA211联合诊断(Y1)与所有检测指标联合诊断(Y2)ROC曲线下面积(area under the cure,AUC)值均大于单项指标诊断(P<0.05)。结论单项指标中CA125诊断胃癌腹膜转移效能最高,其与CA724、CA211联合诊断可作为胃癌腹膜转移的有效诊断方式。
Objective To investigate the diagnostic value of combined detection of serum carcinoembryonic antigen and carbohydrate antigen in gastric cancer peritoneal metastasis. Methods 68 patients with gastric cancer treated in Oncology Department of our hospital from June 2014 to June 2017 were divided into metastasis group(20 cases) and non-metastasis group(48 cases), according to the pathological or cytological examination. The levels of carcinoembryonic antigen(CEA), carbohydrate antigen CA724, CA242, CA211, CA19-9 and CA125 were detected by automatic immunoassay analyzer before operation or chemotherapy. The serum level and positive rate of the two groups were compared. The diagnostic efficiencies of the single and combined detection of these tumor markers were evaluated through establishing Logistic regression model,drawing ROC curves and calculating the areas under the curve(AUC). Results The serum levels of CEA, CA724, CA242, CA211, CA19-9 and CA125 in the metastasis group were significantly higher than those in the non metastasis group, and the difference was statistically significant(P<0.05). The positive rates of serum CA724, CA125 and CA211 in metastasis group were significantly higher than those in non-metastasis group(P<0.05), while no difference was found in the positive rate of the serum CEA, CA242, CA19-9 of the two groups(P>0.05). The AUC of combined detection(Y1) of CA125, CA724 and CA211 or combined detection(Y2) of the all tumor markers was significantly greater than that of any single detection. Conclusion CA125 can be as a predictor for peritoneal metastasis of gastric cancer, and its detection in combination with CA724 and CA211 can provide effective information for clinical identification of gastric cancer peritoneal metastasis.
Objective To investigate the diagnostic value of combined detection of serum carcinoembryonic antigen and carbohydrate antigen in gastric cancer peritoneal metastasis. Methods 68 patients with gastric cancer treated in Oncology Department of our hospital from June 2014 to June 2017 were divided into metastasis group(20 cases) and non-metastasis group(48 cases), according to the pathological or cytological examination. The levels of carcinoembryonic antigen(CEA), carbohydrate antigen CA724, CA242, CA211, CA19-9 and CA125 were detected by automatic immunoassay analyzer before operation or chemotherapy. The serum level and positive rate of the two groups were compared. The diagnostic efficiencies of the single and combined detection of these tumor markers were evaluated through establishing Logistic regression model,drawing ROC curves and calculating the areas under the curve(AUC). Results The serum levels of CEA, CA724, CA242, CA211, CA19-9 and CA125 in the metastasis group were significantly higher than those in the non metastasis group, and the difference was statistically significant(P<0.05). The positive rates of serum CA724, CA125 and CA211 in metastasis group were significantly higher than those in non-metastasis group(P<0.05), while no difference was found in the positive rate of the serum CEA, CA242, CA19-9 of the two groups(P>0.05). The AUC of combined detection(Y1) of CA125, CA724 and CA211 or combined detection(Y2) of the all tumor markers was significantly greater than that of any single detection. Conclusion CA125 can be as a predictor for peritoneal metastasis of gastric cancer, and its detection in combination with CA724 and CA211 can provide effective information for clinical identification of gastric cancer peritoneal metastasis.
引文
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[12] 陈兆武,邓芳,张扬,等.应用ROC曲线评价4种血清肿瘤标志物对胃癌的诊断价值[J].临床输血与检验,2016,18(6):576-580.
[13] Xiao Y,Zhang J,He X,et al.Diagnostic values of carcinoembryonic antigen in predicting peritoneal recurrence after curative resection of gastric cancer:a meta-analysis[J].Irish Journal of Medical Science,2014,183(4):557-564.
[14] 金玉翠,尤巧生.联合检测血清癌胚抗原、糖类抗原125、糖类抗原153在肺癌早期诊断中的意义[J].实用临床医药杂志,2016,20(17):103-104.
[15] 刘博,刘彩霞,刘明.联合检测血清胃蛋白酶原Ⅰ和糖类抗原19-9及癌胚抗原对胃癌诊断的临床价值[J].医学综述,2015,21(2):312-314.
[16] Murakami S,Safomi A,Lshida K,et al.Serum‐soluble interleukin‐2 receptor concentrations in patients with gastric cancer[J].Cancer,2015,74(10):2745-2748.
[17] 朱文芳,沈建军,付涛,等.血清GPDA联合肿瘤标志物对胃癌早期诊断的临床价值[J].现代检验医学杂志,2017,32(4):110-112.
[18] Zhang J,Huang T,Zhang F,et al.Prognostic role of serum carbohydrate antigen 19-9 levels in patients with resectable hepatocellular carcinoma[J].Tumor Biology,2015,36(4):2257-2261.
[19] Kim J R,Jang J,Kang M J,et al.Clinical implication of serum carcinoembryonic antigen and carbohydrate antigen 19‐9 for the prediction of malignancy in intraductal papillary mucinous neoplasm of pancreas[J].Journal of Hepato-Biliary-Pancreatic Sciences,2015,22(9):699-707.
[20] Kim J H,Jun K H,Jung H,et al.Prognostic Value of Preoperative Serum Levels of Five Tumor Markers (Carcinoembryonic Antigen,CA19-9,Alpha-fetoprotein,CA72-4,and CA125) in Gastric Cancer[J].Hepato-gastroenterology,2014,61(131):863.
[2] 刘勇,杨继红,王鹏.LYVE-1在胃癌中的表达及意义[J].泸州医学院学报,2010,33(5):485-489.
[3] 陆晟,朱正纲,LuSheng,等.老年胃癌患者外科治疗与预后的临床特点[J].中华胃肠外科杂志,2016,19(5):596-600.
[4] 徐延钧,宋应明,连长虹.血清糖类抗原72-4、糖类抗原242、糖类抗原19-9、癌胚抗原检测在胃癌诊断中的价值[J].肿瘤研究与临床,2013,25(12):840-842.
[5] Wada N,Kurokawa Y,Miyazaki Y,et al.The characteristics of the serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels in gastric cancer cases[J].Surgery Today,2016,47(2):1-6.
[6] 徐巧玲,尤徐阳,吴娜静,等.临床病理学分析结合CEA、CA19-9与CA125检测对诊断胃癌术后腹膜转移的意义[J].标记免疫分析与临床,2016,23(11):1321-1326.
[7] Polat E,Duman U,Duman M,et al.Diagnostic value of preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 in colorectal cancer[J].Current Oncology,2014,21(1):1-7.
[8] 徐风亮,郑加荣,秦燕,等.血清肿瘤标志物联合动态检测对胃癌诊疗的价值[J].肿瘤研究与临床,2016,28(2):123-126.[赵静,张静琼,雷章.胃癌组织NPM表达及对胃癌患者预后的预测价值[J].西部医学,2017,29(7):894-897.
[10] 孙慧,崔婷允,方岳雨,等.血清肿瘤标志物检测在贲门癌及胃窦癌诊断中的应用价值[J].山西医科大学学报,2014,45(10):950-952.
[11] Jaihwan K,Suk L Y,Kyeom H I,et al.Postoperative Carcinoembryonic Antigen as a Complementary Tumor Marker of Carbohydrate Antigen 19-9 in Pancreatic Ductal Adenocarcinoma[J].Journal of Korean Medical Science,2015,30(3):259-263.
[12] 陈兆武,邓芳,张扬,等.应用ROC曲线评价4种血清肿瘤标志物对胃癌的诊断价值[J].临床输血与检验,2016,18(6):576-580.
[13] Xiao Y,Zhang J,He X,et al.Diagnostic values of carcinoembryonic antigen in predicting peritoneal recurrence after curative resection of gastric cancer:a meta-analysis[J].Irish Journal of Medical Science,2014,183(4):557-564.
[14] 金玉翠,尤巧生.联合检测血清癌胚抗原、糖类抗原125、糖类抗原153在肺癌早期诊断中的意义[J].实用临床医药杂志,2016,20(17):103-104.
[15] 刘博,刘彩霞,刘明.联合检测血清胃蛋白酶原Ⅰ和糖类抗原19-9及癌胚抗原对胃癌诊断的临床价值[J].医学综述,2015,21(2):312-314.
[16] Murakami S,Safomi A,Lshida K,et al.Serum‐soluble interleukin‐2 receptor concentrations in patients with gastric cancer[J].Cancer,2015,74(10):2745-2748.
[17] 朱文芳,沈建军,付涛,等.血清GPDA联合肿瘤标志物对胃癌早期诊断的临床价值[J].现代检验医学杂志,2017,32(4):110-112.
[18] Zhang J,Huang T,Zhang F,et al.Prognostic role of serum carbohydrate antigen 19-9 levels in patients with resectable hepatocellular carcinoma[J].Tumor Biology,2015,36(4):2257-2261.
[19] Kim J R,Jang J,Kang M J,et al.Clinical implication of serum carcinoembryonic antigen and carbohydrate antigen 19‐9 for the prediction of malignancy in intraductal papillary mucinous neoplasm of pancreas[J].Journal of Hepato-Biliary-Pancreatic Sciences,2015,22(9):699-707.
[20] Kim J H,Jun K H,Jung H,et al.Prognostic Value of Preoperative Serum Levels of Five Tumor Markers (Carcinoembryonic Antigen,CA19-9,Alpha-fetoprotein,CA72-4,and CA125) in Gastric Cancer[J].Hepato-gastroenterology,2014,61(131):863.