摘要
目的 探讨微卫星不稳定性(microsatellite instability,MSI)、术前D-二聚体(D-dimer,DD)和CA19-9水平对结直肠癌(colorectal cancer,CRC)根治术患者的预测价值。方法 回顾性分析2020年1月至2021年12月于广西医科大学第一附属医院及桂林市人民医院行根治性手术的81例CRC患者的一般临床资料、肿瘤组织有无MSI、术前DD和CA19-9水平,筛选影响预后的因素并进行评价。结果 复发组与无复发组患者的MSI发生率、术前DD和CA19-9水平差异有统计学意义(P<0.05);死亡组与生存组患者的MSI发生率、术前DD和CA19-9水平差异有统计学意义(P<0.05)。单因素及多因素分析结果显示MSI是CRC术后复发的保护因素(P=0.018);术前DD和CA19-9高表达是CRC术后复发的独立危险因素(P=0.020,P=0.042);MSI是CRC术后死亡的保护因素(P=0.036);术前DD和CA19-9高表达是CRC术后死亡的独立危险因素(P=0.010,P=0.017)。受试者操作特征曲线显示MSI、DD、CA19-9预测复发的曲线下面积(area under the curve,AUC)分别为0.643、0.599、0.644,MSI、DD、CA19-9单独用于预测死亡的AUC分别为0.646、0.642、0.693;三者联合预测复发及死亡的AUC分别为0.776、0.825。结论 CRC根治术患者的MSI是预后的保护因素、术前DD和CA19-9高表达是预后的危险因素,三者联合检测可优化CRC根治术预后评估的准确性。
Objective To evaluate the prognostic value of microsatellite instability(MSI),preoperative D-dimer(DD),and CA19-9 level for the prognosis of colorectal cancer(CRC)patients who had undergone radical resection.Methods Retrospectively analyzed the general clinical data,MSI,DD,and CA19-9 levels of 81 CRC patients who underwent radical resection in the First Affiliated Hospital of Guangxi Medical University and Guilin People’s Hospital between January 2020 and December 2021.Screen and evaluate prognostic factors.Results There was a statistically significant difference in the incidence of MSI,preoperative DD,and CA19-9 expression levels between recurrence group and non recurrence group(P<0.05).There was a statistically significant difference in the incidence of MSI,preoperative DD,and CA19-9 expression levels between death group and survival group(P<0.05).Univariate and multivariate analyses MSI was identified as a protective factor against recurrence(P=0.018),and high levels of preoperative DD and CA19-9 were identified as independent risk factors for recurrence(P=0.020,P=0.042).MSI was identified as a protective factor against mortality in CRC patients(P=0.036),and high levels of preoperative DD and CA19-9 were identified as independent risk factors for mortality in CRC patients(P=0.010,P=0.017).The receiver operating characteristic curve showed that the area under the curve(AUC)of MSI,DD,and CA19-9 for predicting recurrence after CRC surgery were 0.643,0.599,and 0.644 respectively,for mortality,they were 0.646,0.642,and 0.693 respectively.The combined model for predicting recurrence and mortality yielded AUC were 0.776 and 0.825,respectively.Conclusion MSI is a protective factor for prognosis in CRC patients,whereas high levels of preoperative DD and CA19-9 are risk factors for poor prognosis.The combined detection of these three factors can optimize the risk stratification of CRC.
作者
伍忆倩
冯振博
胡洁
WU Yiqian;FENG Zhenbo;HU Jie(Department of Pathology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China;Department of Pathology,Guilin People’s Hospital,Guilin 541002,Guangxi,China)
出处
《中国现代医生》
2025年第24期50-54,共5页
China Modern Doctor
