Pgp1组织表达与术前血清癌胚抗原联合检测在结直肠癌预后判断中的价值  

Predictive value of combination detection of tissue Pgp1 expression and preoperative serum CEA level for colorectal cancer

作　　者：吴帆[1] 陈蕾[1] 吴蔚[1] 姜北海[1] 苏向前[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心四病区恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华胃肠外科杂志》2017年第4期443-449,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金项目（81272766,81450028,81672439）;北京市自然科学基金（7162039）;北京市医院管理局临床医学发展专项经费资助（XM201309,ZYLX201701）;北京大学“985工程”三期临床医院合作专项

摘　　要：目的探讨联合检测癌组织中Pgp1的表达水平和术前血清癌胚抗原（CEA）的水平对结直肠癌患者预后的判断价值。方法回顾性收集2004年1月至2006年8月期间北京大学肿瘤医院胃肠肿瘤中心行结直肠癌根治性手术治疗、肿瘤分期为Ⅰ-Ⅱ期且5年随访资料完整的153例患者的结直肠癌标本及临床病理资料。采用免疫组织化学检测Pgp1表达水平，并采用联合评估染色强度和阳性细胞比例的方法确定表达水平，Pgp1表达（-）和（＋）定义为低表达组，（ ）和（ ）为高表达组：采用化学发光免疫分析法检测血清CEA水平，CEA〉5μg／L表示为阳性。X^2检验或Fisher确切概率法分析Pgp1表达和血清CEA水平与结直肠癌患者不同临床病理特征的关系；Kaplan-Meier法进行生存分析：Cox比例风险回归模型进行单因素和多因素生存分析Pgp1表达和血清CEA水平与患者预后的关系。结果全组153例患者，男性105例，女性48例，平均年龄59（27-90）岁；直肠癌41例，结肠癌112例；TNM分期：Ⅰ期23例，Ⅱ期130例；中位随访时间为64个月，死亡30例。结直肠癌组织中Pgp1表达阳性率为66．0％（101／153），其表达与性别、肿瘤位置、患者随访期的生存情况有关（均P〈0．05）；患者术前血清CEA的阳性率为28．1％（43／153），其表达与肿瘤复发和患者随访期的生存情况有关（均P〈0．05）。Kaplan-Meier生存分析显示，全组患者的5年生存率为81．7％，其中Pgp1高表达患者5年生存率为88．1％，明显高于Pgp1低表达患者的69．2％（P=0．003）；而术前CEA阳性患者5年生存率为72．1％，明显低于术前CEA阴性患者的86．1％（P=0．023）；此外，Pgp1阴性＋CEA阳性和Pgp1阳性＋CEA阴性两组患者的5年生存率分别为66．7％和91．0％，两组比较，差异具有统计学意义（P=0．002）。单因素分析显示，性别、Pgp1表达水平、血清CEA水平Objective To explore the predictive value of combination detection of Pgp1 expression in cancer tissue and serum CEA level for the prognosis of colorectal cancer （CRC） patients. Methods Clinicopathologieal data, complete 5-year follow-up data and CRC tissue samples of 153CRC patients with stage Ⅰ to Ⅱ tumor undergoing radical operation in our department from January 2004 to August 2006 were retrospectively collected. Immunohistochemieal staining was used to detect the expression level of Pgp1. The combined evaluation of staining intensity and positive cell percentage was performed to determine the expression level of Pgp1. Pgp1 staining （-） and （＋） was defined as low expression; and staining （＋＋ ） and （＋＋＋） as high expression. Electroehemilumineseence immunoassay was used to detect the level of serum CEA. CEA〉 5μg/L was defined as positive. X^2 and Fisher＇s exact test were performed to analyze the association of Pgp1 expression with CEA level and clinicopathological variables. Moreover, Kaplan-Meier method was used to analyze the survival. Univariate and multivariate Cox proportional hazard regression models were used to evaluate the roles of Pgp1 expression combined with serum CEA level in prognosis prediction. Results Of 153 patients, 105 were males and 48 females with mean age of 59 （27 to 90） years; 41 eases were rectal cancer, and 112 eases colon cancer; 23 patients were TNM stage Ⅰ tumor, and 130 patients stage Ⅱ tumor; median follow-up time was 64 months; 30 eases were dead. Positive rate of Pgp1 expression in colorectal cancer tissues was 66.0% （101/153）. The expression of Pgp1 was associated with gender, tumor location, and survival during the follow-up （all P 〈0.05）. The preoperative positive rate of serum CEA was 28.1% （43/153）. The preoperative serum CEA level was associated with tumor recurrence and survival （all P 〈 0.05）. Kaplan-Meier analysis showed the overall 5-year survival rate was 81.7%. The 5-year survival rate of patient

关 键 词：结直肠肿瘤 细胞黏附分子 Pgp1 癌胚抗原 联合检测 预后 

分 类 号：R735.34[医药卫生—肿瘤]