国际肿瘤学杂志

国际肿瘤学杂志 ›› 2017, Vol. 44 ›› Issue (8): 662-667.doi: 10.3760/cma.j.issn.1673422X.2017.09.005

• 论著 • 上一篇    下一篇

结肠癌根治术患者围手术期血清癌胚抗原水平下降与患者预后的关系

黄江, 张生军, 白利杰, 常琦   

  1. 716000 延安大学附属医院普外科
  • 出版日期:2017-09-08 发布日期:2017-10-31
  • 通讯作者: 白利杰，Email: 13891126150@163.com E-mail:13891126150@163.com

Relationship between the decrease of serum level of carcinoembryonic antigen during perioperative period and the prognosis in patients with colon cancer

Huang Jiang, Zhang Shengjun, Bai Lijie, Chang Qi.   

  1. Department of General Surgery, Affiliated Hospital of Yan′an University, Yan′an 716000, China
  • Online:2017-09-08 Published:2017-10-31
  • Contact: Bai Lijie E-mail:13891126150@163.com

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摘要： 目的评估结肠癌根治术患者围手术期血清癌胚抗原（CEA）水平下降率对患者预后的意义。方法回顾性分析2006年1月至2011年4月间行结肠癌根治术的605例患者临床资料，分析患者术前血清CEA水平与不同临床病理特征的关系。根据术前血清CEA水平进行分组，分为≤5 ng/ml组和＞5 ng/ml组。计算术前血清CEA>5 ng/ml患者CEA水平下降率的临界值。进行术后血清CEA临界值与患者生存关系分析。单变量和多变量进行术前CEA水平>5 ng/ml患者总生存率（OS）和无瘤生存率(DFS)预后因素分析。结果患者术前血清CEA水平与淋巴管浸润（χ2=14.122，P＜0.001）、T分期（χ2=40.153，P＜0.001）、N分期（χ2=22.721，P＜0.001）和病理分期（χ2=38.576，P＜0.001）有关，而与性别（χ2=0.453，P=0.501）、年龄（χ2=0.195，P=0.659）、组织分级（χ2=6.135，P=0.112）无关。术前CEA>5 ng/ml患者OS及DFS的CEA下降率临界值分别为48.95%和50.81%。术后CEA水平下降率低于和高于临界值患者的5年OS分别为31.37%和76.63%，差异有统计学意义（χ2=43.235，P＜0.001），而5年DFS则分别为27.69%和72.10%，差异有统计学意义（χ2=55.561，P＜0.001）。单因素分析，CEA下降率为术前血清>5 ng/ml患者OS及DFS的预后影响因素（χ2=43.235，P＜0.001；χ2=55.561，P＜0.001），此外N分期与病理分期也为OS（χ2=14.683，P＜0.001；χ2=12.295，P＜0.001）和DFS（χ2=16.212，P＜0.001；χ2=13.704，P＜0.001）的预后因素。多因素分析显示，CEA下降率和N分期为术前血清>5 ng/ml患者OS（χ2=18.885，P＜0.001；χ2=7.523，P＜0.001）和DFS（χ2=19.275，P＜0.001；χ2=6.997，P＜0.001）的预后因素。结论结肠癌根治术前血清高CEA水平患者，其术后CEA降低率超过临界值可作为患者预后的一个有利因素。

关键词: 结肠肿瘤, 外科手术, 手术期间, 癌胚抗原, 预后

Abstract: ObjectiveTo evaluate the association between the decrease of the perioperative serum carcinoembryonic antigen (CEA) level during perioperative period and the prognosis in patients with colon cancer after a curative resection. MethodsRetrospective analysis was conducted to evaluate the relationship between preoperative serum CEA level and different clinicopathologic features in 605 cases who underwent a curative resection for colon cancer from January 2006 to April 2011. According to the preoperative serum CEA level, the patients were divided into two groups: ≤5 ng/ml and  >5 ng/ml group. The critical value of the CEA decreasing rate in preoperative serum CEA >5 ng/ml group was calculated, and the relationship between this critical value and survival rate was then analyzed. Univariate and multivariate models were used to detect the risk factors of overall survival rate (OS) and disease free survival (DFS) in preoperative serum CEA >5 ng/ml patients.  ResultsThe preoperative serum CEA levels were significantly associated with lymphatic invasion (χ2=14.122, P＜0.001), T stages (χ2=40.153, P<0.001), N stages (χ2=22.721, P<0.001) and pathological stages (χ2=38.576, P<0.001), except for sex (χ2=0.453, P=0.501), age (χ2=0.195, P=0.659) and histological stages (χ2=6.135, P=0.112). The critical values of CEA decreasing rate for OS and DFS were 48.95% and 50.81% in preoperative serum CEA >5 ng/ml group respectively. There were significant differences of 5year OS (31.37% vs. 76.63%, χ2=43.235， P＜0.001) and 5year DFS (27.69% vs. 72.10%, χ2=55.561，P＜0.001) between patients after operation whose CEA decreasing rate were lower than critical value and those whose were higher. Univariate analysis showed that the decreasing rate of CEA was an influence factor for OS (χ2=43.235， P＜0.001) and DFS (χ2=55.561， P＜0.001) of preoperative serum CEA >5 ng/ml patients. The N stages and pathological stages were both related to OS (χ2=14.683， P＜0.001； χ2=12.295， P<0.001) and DFS (χ2=16.212， P＜0.001； χ2=13.704， P<0.001) respectively. Multivariate model showed that the decreasing rate of CEA level and N stages were both associated with OS (χ2=18.885， P＜0.001； χ2=7.523， P＜0.001) and DFS (χ2=19.275， P＜0.001； χ2=6.997， P＜0.001) of preoperative serum CEA >5 ng/ml patients. ConclusionA high decreasing rate of serum CEA level after operation in colon cancer patients who have high CEA levels before the curative resection can be a protective factor for prognosis, especially when the decreasing rate is higher than the critical value.

Key words: Colonic neoplasms, Surgical procedures, operative, Perioperative period, Carcinoembryonic antigen, Prognosis