CAJ | 학술논문

目的：探讨术前血清癌胚抗原﹙CEA)水平显著升高﹙大于50μg/L)结肠癌患者的临床病理特征及其预后。方法回顾性分析2001年1月至2011年12月接受手术治疗切除原发灶并有完整随访资料的结肠腺癌患者1250例的临床病理资料。根据术前血清CEA水平,将全组患者分为CEA正常组﹙低于5μg/L,721例)、CEA升高组﹙5~50μg/L,408例)和CEA显著升高组﹙大于50μg/L,121例)。 Kaplan-Meier 法进行总生存时间和无病生存时间分析,Log-rank 检验比较各组的生存情况,Cox回归分析筛选结肠癌的独立预后因素。结果与CEA正常组和CEA升高组比较,CEA显著升高组患者表现为更晚的T分期﹙P<0.01)、N分期﹙P<0.01)、M分期﹙P<0.01)及TNM分期﹙P<0.01)；且更多患者出现脉管癌栓﹙P<0.01),更多患者接受姑息性手术﹙P<0.01)。术后随访中,CEA显著升高组发生术后总体远处转移和肝转移比例显著增高﹙均P=0.001)。接受根治性手术后,CEA正常组、CEA 升高组和CEA 显著升高组患者5年生存率分别为70.1%、54.4%和42%,各组间差异有统计学意义﹙P<0.01)。多因素分析显示,肿瘤分化程度﹙P<0.01)、术后TNM分期﹙P<0.01)、术前CEA水平﹙P<0.01)和脉管癌栓﹙P<0.01)以及辅助化疗﹙P<0.01)是结肠癌的独立预后因素。结论术前血清CEA显著升高的结肠癌患者肿瘤TNM分期更晚,术后发生肝转移的比例增多；术前CEA水平的升高程度是结肠癌患者的独立预后因素。
목적：탐토술전혈청암배항원﹙CEA)수평현저승고﹙대우50μg/L)결장암환자적림상병리특정급기예후。방법회고성분석2001년1월지2011년12월접수수술치료절제원발조병유완정수방자료적결장선암환자1250례적림상병리자료。근거술전혈청CEA수평,장전조환자분위CEA정상조﹙저우5μg/L,721례)、CEA승고조﹙5~50μg/L,408례)화CEA현저승고조﹙대우50μg/L,121례)。 Kaplan-Meier 법진행총생존시간화무병생존시간분석,Log-rank 검험비교각조적생존정황,Cox회귀분석사선결장암적독립예후인소。결과여CEA정상조화CEA승고조비교,CEA현저승고조환자표현위경만적T분기﹙P<0.01)、N분기﹙P<0.01)、M분기﹙P<0.01)급TNM분기﹙P<0.01)；차경다환자출현맥관암전﹙P<0.01),경다환자접수고식성수술﹙P<0.01)。술후수방중,CEA현저승고조발생술후총체원처전이화간전이비례현저증고﹙균P=0.001)。접수근치성수술후,CEA정상조、CEA 승고조화CEA 현저승고조환자5년생존솔분별위70.1%、54.4%화42%,각조간차이유통계학의의﹙P<0.01)。다인소분석현시,종류분화정도﹙P<0.01)、술후TNM분기﹙P<0.01)、술전CEA수평﹙P<0.01)화맥관암전﹙P<0.01)이급보조화료﹙P<0.01)시결장암적독립예후인소。결론술전혈청CEA현저승고적결장암환자종류TNM분기경만,술후발생간전이적비례증다；술전CEA수평적승고정도시결장암환자적독립예후인소。
Objective To explore the clinicopathological characteristics and prognosis of colon cancer patients with extremely elevated serum carcinoembryonic antigen ﹙CEA) level before operation﹙>50 μg/L). Methods Clinicopathological and follow-up data of 1250 patients with colonic adenocarcinoma undergoing primary tumor resection between January 2001 and December 2011 were retrospectively analyzed. All the patients were divided into three groups according to the preoperative serum CEA levels as normal group ﹙0-5 μg/L, 721 cases), elevated group ﹙5-50 μg/L, 408 cases) and extremely elevated ﹙>50 μg/L, 121 cases). Kaplan-Meier method was used to analyze the overall survival and disease-free survival. Log-rank test was used to compare the survival between groups. Cox regression was used to screen the independent prognostic factors of colon cancer. Results Compared with normal and elevated groups, patients with extremely elevated CEA had more advanced T,N,M stages ﹙P<0.01), more palliative surgery ﹙P<0.01) and more lymphovascular invasion﹙P<0.01). During the follow-up, patients with extremely elevated CEA demonstrated significantly higher ratio of distant metastases and liver metastases ﹙both P=0.001). After radical surgery, 5-year overall survival rate of patients with normal, elevated and extremely elevated CEA levels was 70.1%, 54.4% and 42%, respectively, with statistically significant difference among three groups ﹙P<0.001). Multivariate analysis showed that tumor differentiation, TNM staging, preoperative CEA levels, lymphovascular invasion and adjuvant chemotherapy were independent prognostic factors for colon cancer ﹙all P<0.01). Conclusions Colon cancer patients with extremely elevated preoperative CEA levels are associated with more unfavorable pathological factors, advanced TNM stage and more distant metastases﹙especially the liver metastases) during the follow-up. The elevated degree of preoperative CEA level is an independent poor prognostic factor of patients with colon cancer.