癌胚抗原预测食管癌淋巴结转移的临床价值  

Clinical value of preoperative serum carcinoembryonic antigen detection in the prediction of esophageal cancer lymph node metastasis

作　　者：赵彦[1] 游宾[1] 侯生才[1] 胡滨[1] 陈其瑞[1] 李辉[1] 

机构地区：[1]首都医科大学附属北京朝阳医院胸外科,100020

出　　处：《中华消化外科杂志》2015年第12期1006-1011,共6页Chinese Journal of Digestive Surgery

摘　　要：目的 探讨术前血清CEA表达水平预测食管癌淋巴结转移的临床价值.方法 回顾性分析2010年12月至2014年1月首都医科大学附属北京朝阳医院收治的111例食管癌患者的临床资料.患者术前行血清CEA检测和胸部增强CT检查.根据患者的具体情况,选择手术方式：左侧开胸食管癌根治术、经腹右胸食管癌根治术（开腹和腹腔镜手术）、经颈胸腹三切口食管癌根治术（开腹和腹腔镜手术）、单纯经腹切口食管癌根治术.食管肿瘤位置和食管癌TNM分期标准均采用国际相关标准.单因素分析中计数资料比较采用卡方检验或Fisher确切概率法,等级资料比较采用秩和检验;多因素分析采用逐步Logistic回归模型;应用受试者工作特征曲线（ROC曲线）评价血清CEA水平及胸部增强CT检查诊断食管癌淋巴结转移的诊断价值;将111例患者CEA检测结果行四分位数间距划分为4组,采用卡方检验比较4组淋巴结转移率.结果 111例患者术前均行血清CEA检测和胸部增强CT检查,均顺利完成手术,其中左侧开胸食管癌根治术40例,经腹右胸食管癌根治术56例,经颈胸腹三切口食管癌根治术8例,单纯经腹手术7例.肿瘤位置：胸上段食管癌3例,胸中段食管癌52例,胸下段食管癌36例,食管胃接合处肿瘤20例.术后病理学类型：鳞癌84例,腺癌23例,其他4例.淋巴结转移情况：淋巴结转移阴性44例,淋巴结转移阳性67例.111例食管癌患者血清CEA升高阳性率为36.04％ （40/111）.影响食管癌患者血清CEA阳性率的单因素分析结果表明：肿瘤位置、病理学类型、肿瘤N分期是影响患者血清CEA阳性率的临床病理因素（Z=6.815,6.608,16.928,P＜0.05）;进一步多因素分析结果表明：肿瘤N3期是影响患者血清CEA阳性率的独立危险因素（OR=2.206,95％ CI：1.370 -3.552,P＜0.05）.影响食管癌患者淋巴结转移的单因素分析结果显示：肿瘤T分期与血清CEA水平是影响�Objective To investigate the clinical value of preoperative serum carcinoembryonic antigen （CEA） detection in the prediction of esophageal cancer lymph node metastasis.Methods The clinical data of 111 patients with esophageal cancer who were admitted to the Chaoyang Hospital of Capital Medical University between December 2010 and January 2014 were retrospectively analyzed.Patients received preoperative serum CEA examination and enhanced CT of the chest.The surgical procedures were selected according to the condition of patients, including radical resection of esophageal cancer via left thoracic approach, transabdominal right thoracic approach （open and laparoscopic surgeries）, cervico-thoracic-abdominal triple incision （open and laparoscopic surgeries） and transabdominal incision.The international standard was used for tumor location and TNM stage of esophageal cancer.The count data and comparison of ordinal data in the univariate analysis were analyzed using the chi-square test, Fisher exact probability and rank-sum test, respectively.The multivariate analysis was done using the stepwise logistic regression.The ROC curve was used for evaluating diagnostic value of serum CEA examination and enhanced CT of the chest.All the 111 patients were divided into 4 groups according to the interquartile range results of the CEA examination, and the lymph node metastasis rates of 4 groups were compared by the chi-square test.Results All the 111 patients underwent successful radical resection of esophageal cancer after preoperative serum CEA detection and enhanced CT of the chest, including 40 via left thoracic approach, 56 via transabdominal right thoracic approach, 8 via cervico-thoracic-abdominal triple incision and 7 via transabdominal incision.There were 3 patients with upper thoracic esophageal cancer, 52 with middle thoracic esophageal cancer, 36 with lower thoracic esophageal cancer and 20 with cancer of gastro-esophageal junction.The postoperative pathological type included 84 squamous cell carcinomas, 23

关 键 词：食管肿瘤 癌胚抗原 淋巴结转移 

分 类 号：R735.1[医药卫生—肿瘤]