CAJ | 학술논문

背景与目的:癌胚抗原(carcinoembryonic antigen,CEA)监测在指导恶性肿瘤特别是结直肠癌的治疗中起重要作用.CEA半衰期作为一个较新的指标,也被应用于恶性肿瘤的监测.本研究通过检测结直肠患者术前和术后短期内的CEA水平,并计算CEA半衰期,以判断将它作为预后因素的可能性.方法:回顾性选取98例术前CEA水平升高(≥5 μg/L)并有常规的术后早期CEA监测的结直肠癌根治术后患者作为研究对象.计算术后CEA半衰期.并分析它与预后的关系.结果:98例患者中.21例发生复发或远处转移,77例无复发转移.复发组术前CEA中位值(23.9μg/L)显著高于未复发组(12.3 μg/L)(P=0.010);复发组术后CEA半衰期中位值为6.2天,显著长于未复发组(4.7天)(P=0.042);疾病分期越晚,预后越差(P<0.001).术后CEA半衰期较短的患者与半衰期较长的患者相比,3年无病生存率(87%vs.66%,P=0.017)和3年总生存率(90%vs.80%.P=0.032)都较高;TNM分期较早的患者无病生存率和总生存率均较高,Ⅰ、Ⅱ、Ⅲ期患者的3年无病生存率分别为100%、93%和55%(P<0.001),3年总生存率分别为100%、98%和77%(P=0.192).Cox回归分析表明.TNM分期和术后CEA半衰期是术前CEA水平升高的结直肠癌患者的独立预后因素.结论:除TNM分期外.CEA半衰期也可作为术前CEA水平升高的结直肠癌患者的独立预后因素.根治术后CEA半衰期延长的患者预后较差.
배경여목적:암배항원(carcinoembryonic antigen,CEA)감측재지도악성종류특별시결직장암적치료중기중요작용.CEA반쇠기작위일개교신적지표,야피응용우악성종류적감측.본연구통과검측결직장환자술전화술후단기내적CEA수평,병계산CEA반쇠기,이판단장타작위예후인소적가능성.방법:회고성선취98례술전CEA수평승고(≥5 μg/L)병유상규적술후조기CEA감측적결직장암근치술후환자작위연구대상.계산술후CEA반쇠기.병분석타여예후적관계.결과:98례환자중.21례발생복발혹원처전이,77례무복발전이.복발조술전CEA중위치(23.9μg/L)현저고우미복발조(12.3 μg/L)(P=0.010);복발조술후CEA반쇠기중위치위6.2천,현저장우미복발조(4.7천)(P=0.042);질병분기월만,예후월차(P<0.001).술후CEA반쇠기교단적환자여반쇠기교장적환자상비,3년무병생존솔(87%vs.66%,P=0.017)화3년총생존솔(90%vs.80%.P=0.032)도교고;TNM분기교조적환자무병생존솔화총생존솔균교고,Ⅰ、Ⅱ、Ⅲ기환자적3년무병생존솔분별위100%、93%화55%(P<0.001),3년총생존솔분별위100%、98%화77%(P=0.192).Cox회귀분석표명.TNM분기화술후CEA반쇠기시술전CEA수평승고적결직장암환자적독립예후인소.결론:제TNM분기외.CEA반쇠기야가작위술전CEA수평승고적결직장암환자적독립예후인소.근치술후CEA반쇠기연장적환자예후교차.
BACKGROUND & OBJECTIVE:Carcinoembryonic antigen(CEA) monitoring plays an important role in the management of malignancies,especially in colorectal cancer (CRC).The half-life (T1/2) of CEA has also been applied as a new predictor in the surveillance of some malignancies.This study was to examine the preoperative and early postoperative levels of CEA in CRC patients and calculate postoperative T1/2 of CEA to evaluate its potential role in prognosis prediction.METHODS:In this retrospective study, 98 CRC patients who had preoperatively elevated levels of CEA (≥5 μg/L)and serum CEA surveillance after radical operation were included.Postoperative T1,2 of CEA was calculated.Its correlation to prognosis was analyzed.RESULTS:Of the 98 patients,21 had local recurrence or distant metastasis (recurrence group),77 had no recurrence (non-recurrence group).The median value of preoperative CEA level was significantly higher in recurrence group than in non-recurrence group (23.9 μg/L vs.12.3 μg/L,P= 0.010);the median value of postoperative T1/2 of CEA was significantly longer in recurrence group than in non-recurrence group (6.2 days vs.4.7 days,P=0.042);the later the TNM stage was,the poorer the prognosis was (P<0.001).The 3-year disease-free survival (DFS) rate and overall survival (OS) rate were significantly higher in the patients with postoperative T1/2 of CEA of<4.8 days than in those with T1/2 of ≥4.8 days (87% vs.66%,P=0.017;90% vs.80%,P=0.032).The patients at earlier TNM stage had survival benefits both in DFS and OS:the 3-year DFS rates in stage Ⅰ,Ⅱ,and Ⅲ patients were 100%,93%,and 55%,respectively (P<0.001);the 3-year OS rates were 100%,98%,and 77%,respectively (P=0.192).In Cox regression analysis,both TNM stage and postoperative T1/2 of CEA were confirmed to be independent prognostic factors of CRC patients with preoperatively elevated CEA level.CONCLUSIONS:In addition to TNM stage,the T1/2 of CEA may be an independent prognostic factor in CRC patients with preoperatively elevated CEA level.The patients with longer T1/2 of CEA after radical operation have poorer prognosis.