CAJ | 학술논문

目的：评估术前检测癌胚抗原（CEA）和糖链抗原199（CA199）对结直肠癌Ⅱ～Ⅲ期患者预后的判断价值。方法回顾性分析2004—2006年间北京大学肿瘤医院经病理学确诊并接受根治性手术切除的266例Ⅱ～Ⅲ期结直肠癌患者的临床病理及随访资料。分别比较术前CEA升高与CEA正常患者、CA199升高和CA199正常患者的5年总生存率和无病生存率，并分析影响患者总生存率和无病生存率的危险因素。结果全组266例患者中，术前CEA升高119例（44．7％）、CA199升高74例（27．8％）。中位随访时间63月，与术前CEA正常患者相比，CEA升高患者的5年总生存率和5年无病生存率均明显降低[分别为（54．6％比72．8％）和（75．2％比83．3％），P＝0．001和P＝0．042]。与术前CA199正常患者相比，CA199升高患者的5年总生存率和5年无病生存率均明显降低[分别为（45．9％比71．9％）和（74．2％比81．8％），P＝0．000和P＝0．047]。多因素分析显示，男性（HR＝3．016，95％ CI：1．536～5．919，P＝0．001）、淋巴结转移（HR＝2．278，95％ CI：1．272～4．081，P＝0．006）及术前CEA升高（HR＝1．794，95％ CI：1．022～3．149，P＝0．042）是影响患者无病生存的独立危险因素；而肿瘤浸润脉管（HR＝2．041，95％ CI：1．294～3．221，P＝0．002）、淋巴结转移（HR＝2．480，95％CI：1．548～3．972，P＝0．000）及术前CA199升高（HR＝2．145，95％ CI：1．414～3．254，P＝0．000）是影响患者总体生存的独立危险因素。结论术前CEA和CA199检测可以作为Ⅱ～Ⅲ期结直肠癌患者预后判断的参考指标。
목적：평고술전검측암배항원（CEA）화당련항원199（CA199）대결직장암Ⅱ～Ⅲ기환자예후적판단개치。방법회고성분석2004—2006년간북경대학종류의원경병이학학진병접수근치성수술절제적266례Ⅱ～Ⅲ기결직장암환자적림상병리급수방자료。분별비교술전CEA승고여CEA정상환자、CA199승고화CA199정상환자적5년총생존솔화무병생존솔，병분석영향환자총생존솔화무병생존솔적위험인소。결과전조266례환자중，술전CEA승고119례（44．7％）、CA199승고74례（27．8％）。중위수방시간63월，여술전CEA정상환자상비，CEA승고환자적5년총생존솔화5년무병생존솔균명현강저[분별위（54．6％비72．8％）화（75．2％비83．3％），P＝0．001화P＝0．042]。여술전CA199정상환자상비，CA199승고환자적5년총생존솔화5년무병생존솔균명현강저[분별위（45．9％비71．9％）화（74．2％비81．8％），P＝0．000화P＝0．047]。다인소분석현시，남성（HR＝3．016，95％ CI：1．536～5．919，P＝0．001）、림파결전이（HR＝2．278，95％ CI：1．272～4．081，P＝0．006）급술전CEA승고（HR＝1．794，95％ CI：1．022～3．149，P＝0．042）시영향환자무병생존적독립위험인소；이종류침윤맥관（HR＝2．041，95％ CI：1．294～3．221，P＝0．002）、림파결전이（HR＝2．480，95％CI：1．548～3．972，P＝0．000）급술전CA199승고（HR＝2．145，95％ CI：1．414～3．254，P＝0．000）시영향환자총체생존적독립위험인소。결론술전CEA화CA199검측가이작위Ⅱ～Ⅲ기결직장암환자예후판단적삼고지표。
Objective To investigate the predictive value of preoperative detection of CEA and CA199 for prognosis in patients with stage Ⅱ-Ⅲ colorectal cancer (CRC). Methods Clinicopathological and follow-up data of 266 patients with stage Ⅱ-Ⅲ colorectal cancer confirmed by pathology and undergoing radical resection in our department from 2004 to 2006 were retrospectively analyzed. The 5-year overall survival(OS) and disease-free survival(DFS) between normal CEA patients and increased CEA ones, and normal CA199 patients and increased CA199 ones were compared respectively. Moreover, the risk factors of OS and DFS were examined. Results Among these 266 patients, 119 (44.7%) had preoperative elevated CEA, and 74 (27.8%) had increased CA199. The median follow-up time was 63 months. Kaplan-Meier survival curves indicated that patients with elevated preoperative CEA had worse 5-year overall survival (OS) (54.6% vs. 72.8%, P=0.001) and disease-free survival (DFS)(75.2% vs. 83.3%, P=0.042) than those with normal CEA respectively. Meanwhile, patients with elevated CA199 had worse OS(45.9% vs. 71.9%, P=0.000) and DFS (74.2% vs. 81.8%, P=0.047) than those with normal CA199 respectively. Multivariate analysis revealed that male (HR=3.016, 95% CI:1.536-5.919, P=0.001), lymph node metastasis (HR=2.278, 95% CI:1.272-4.081, P=0.006), and preoperative elevated CEA (HR =1.794, 95% CI:1.022-3.149, P =0.042) were independent prognostic factors of DFS. While vascular thrombosis (HR=2.041, 95% CI:1.294-3.221, P=0.002), lymph node metastasis (HR=2.480, 95% CI:1.548-3.972, P=0.000), and preoperative elevated CA199 (HR=2.145, 95% CI:1.414-3.254, P=0.000) were independent prognostic factors of OS in patients with stage Ⅱ-Ⅲ CRC. Conclusion Combined detection of preoperative CEA and CA199 can be used in evaluating the prognosis of patients with stage Ⅱ-Ⅲ CRC.