摘要
目的 探讨血清癌胚抗原（CEA）、唾液酸化岩藻戊糖（CA199）、胃肠道癌抗原（CA242）、甲胎蛋白（AFP）、胃癌及卵巢癌抗原（CA724）对胃癌的诊断及患者的预后评价价值.方法 回顾性分析诊断为胃癌并接受手术治疗的108例患者,应用电化学发光和酶联免疫法检测外周血清CEA、CA199、CA242、CA724、AFP水平.以108例胃癌患者标本绘制5种标志物受试者工作曲线（ROC）;Kaplan-Meier 法分析胃癌患者生存时间;Cox比例风险模型分析影响胃癌患者预后的因素.结果 CEA、CA199、CA242、CA724诊断胃癌的ROC曲线AUC分别为0.735,0.714,0.598,0.576.检测敏感度、特异度、约登指数分别为40.2％、97.7％、0.379;43.0％、91.3％、0.343;35.2％、94.8％、0.300;31.3％、95.3％、0.266.CEA、CA199、CA242、CA724联合诊断胃癌的敏感度、特异度、约登指数分别为76.8％、82.3％、0.585.CEA、CA724与淋巴结转移相关（均P＜ 0.05）;血清CEA、CA199、CA242水平与脉栓、远处转移相关及腹腔积液形成有关（均P＜0.05）.肿块型和导管型患者血清AFP的水平高于浸润性和溃疡型患者（P＜0.05）.肿瘤大小与CEA、AFP、CA724有关.Cox逐步回归分析显示,影响患者3年生存期的因素有术前CEA浓度＞3 μg/ml（P=0.000）、淋巴结转移（P=0.002）.随访59例患者中34例死亡,术前CEA阴性与阳性患者中位生存期分别为18.1、10.9个月（P＜0.005）.结论 联合检测血清CEA、CA199、CA242、CA724可提高胃癌检出率,同时对预测胃癌患者的复发、转移;术前CEA为胃癌患者唯一不良预后指标.
Objective To investigate the serum CEA, CA199, CA242, CA724, AFP levels as tumor markers for diagnosis and prognosis of gastric cancer. Methods The serum concentrations of CEA, CA199, CA724, AFP were detected in 108 patients with gastric cancer by ECLIA （electrochemiluminescence immunoassay） method. CA242 by ELISA method. The survival analysis was performed by the Kaplan-Meier method, Cox＂ s proportional hazards model was used for multivariate analysis of prognosis. Results Using healthy subjects group as control, the ROC-AUC of CEA, CA199, CA242, CA724 were 0.735, 0.714, 0.598, 0.576. The sensitivity, specificity and Youden index were 40.2 %, 97.7 %, 0.379; 43.0 %, 91.3 %, 0.343; 35.2 %, 94.8 %, 0.300 and 31.3 %, 95.3 %, 0.266, respectively. For combined detection of CEA, CA199, CA242, CA724, the sensitivity, specificity and Youden Index were 76.8 %, 82.3 %, 01585. The levels of CEA, CA724 were closely related to lymph node status （both P 〈 0.05）. The concentrations of CEA, CA199, CA242 were significantly related to vascular embolization, distant metastases and ascites （all P 〈 0.05）. The patients of lump and catheter had significantly higher of AFP compared with patients of invasion and anabrosis （P 〈 0.05）. In gastric cancer patients, the size of the primary tumors was closely related to the preoperative serum levels of CEA, AFP, CA724 （P 〈 0.05）. During follow-up, there were 34 cases of death in 59 patients, and the median survival time were 18.1, 10.9 months for the patients with CEA negative and positive （P 〈 0.005）. Conclusions Combing detection of CEA, CA199, CA242, CA72 can improve sensitivity of gastric cancer, and play an important role in forecasting the recurrence, metastasis, curing and prognosis evaluation. CEA is an important predictor of recurrence and prognosis of gastric cancer.
出处
《肿瘤研究与临床》
CAS
2014年第3期183-186,共4页
Cancer Research and Clinic
关键词
胃肿瘤
肿瘤标志物
预后评估
诊断
Stomach neoplasms
Tumor markers
Prognosis evaluation
Diagnosis
