肿瘤标志物、K-ras和p53突变对胰腺癌诊断的价值  

The diagnostic value of serum carcinoma markers, fecal K-ras and p53 gene mutation in pancreatic cancers

作　　者：吴晰[1] 陆星华[1] 徐彤[1] 钱家鸣[1] 赵平[2] 郭晓钟[3] 杨晓鸥[1] 蒋卫君[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院消化内科,100730 [2]中国医学科学院肿瘤医院 [3]沈阳军区总医院

出　　处：《中华内科杂志》2005年第10期741-744,共4页Chinese Journal of Internal Medicine

基　　金：卫生部部属(管)医疗机构临床学科重点项目资助(20010102)

摘　　要：目的评价血清肿瘤标志物CA19-9、CA242、CA50、癌胚抗原和粪便K-ras以及p53基因突变对胰腺癌诊断的价值.方法收集2002年2月至2004年3月在北京协和医院、中国医学科学院肿瘤医院和沈阳军区总医院确诊的新发胰腺癌患者136例,良性消化系统疾病患者240例,进行血清肿瘤标志物和粪便K-ras、p53基因突变的检测.根据结果绘制不同检测方法的受试者工作特征(ROC)曲线,计算ROC曲线下面积,并确定最佳阳性分界值.结果血清CA19-9和CA242的ROC曲线下面积分别为0.855±0.031(95%可信区间0.794～0.916)和0.859±0.031(95%可信区间0.799～0.920),最佳阳性分界值分别为68 U/ml和25 U/ml,其诊断胰腺癌的敏感性分别为84.4%(98/116)和88.4%(84/95),特异性分别为84.3%(145/172)和79.1%(144/182).粪便K-ras和 p53基因突变诊断胰腺癌的敏感性分别为77.8%和27.8%,特异性分别为82.2%和95.2%.将粪便K-ras和 p53基因突变与血清CA19-9和CA242测定相结合计算胰腺癌诊断评分,绘制有序分类资料的ROC 曲线,其曲线下面积为0.946±0.017(95%可信区间0.912～0.980),最佳阳性分界值为2分.结论血清CA19-9及CA242对胰腺癌诊断具有相似价值;联合粪便K-ras及p53突变的检测,通过胰腺癌可能性积分,可以显著提高胰腺癌的诊断效率.Objective To evaluate the diagnostic value of serum carcinoma markers CA19-9, CA2A2, CA50 and carcinoembryonic antigens （ CEA）, fecal K-ras and p55 gene mutation in pancreatic cancer. Methods We collected 136 new cases of pancreatic cancer and 240 patients with benign digestive diseases including 49 patients with benign pancreatic diseases diagnosed in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Tumor Hospital and Shenyang PLA General Hospital from February 2002 to March 2004. Blood samples were collected and serum carcinoma markers CA19-9, CA242, CA50 and CEA were measured. Fecal K-ras and p53 gene mutation were also measured. We decided the optimal cut-off points with receiver operating characteristic curves and calculated the areas under the curve （AUC）. Results The AUC of serum CA19-9 and CA242 were 0. 855 ± 0. 031 （95% CI 0. 794- 0. 916） and 0. 859±0. 031 （95% CI 0. 799-0. 920） respectively. The optimal cut-off point for serum CA19- 9 was 68 U/ml, with the sensitivity of 84. 4% （98/116） and the specificity of 84. 3% （145/172） for the diagnosis of pancreatic cancer. The optimal cut-off point for serum CA242 was 25 U/ml, with the sensitivity of 88.4% （84/95） and the specificity of 79. 1% （144/182）. The sensitivity of fecal K-ras mutation was 77.8% , and the specificity was 82. 2%. The sensitivity and specificity of fecal p53 gene mutation were 27.8% and 95.2% respectively. The diagnostic scale of pancreatic cancer was calculated by four variables ： serum CA19-9, CA242, fecal K-ras and p53, of which each variable deserved one point if measuredpositive. The optimal cut-off point for the scale was 2, and the AUC of the diagnostic scale was 0. 946 ± 0. 017 （95% CI 0. 912-0. 980）. Conclusions Serum CA19-9 and CA242 are valuable diagnostic tools for pancreatic cancer. The diagnostic value will be further improved when they are combined with the measurement of fecal K-ras and p53 gene mutation.

关 键 词：胰腺肿瘤 基因 p53 基因 ras 突变 

分 类 号：R735.9[医药卫生—肿瘤]