肿瘤标志物和炎性指标对结直肠癌诊断和化疗不良反应预测的临床价值  

Application values of tumor markers and inflammatory markers in diagnosis of colorectal cancer and prediction of chemotherapy-related adverse effects

作　　者：陈伟[1] 李明明 姚厚山[2] 李新星[2] 臧佳 何建华 李斌[1] 吕金典 位华[1] 陈万生[1] CHEN Wei;LI Mingming;YAO Houshan;LI Xinxing;ZANG Jia;HEJianhua;LI Bin;LU Jindian;WEI Hua;CHEN Wansheng(Department of Pharmacy,Shanghai Changzheng Hospital,Second Military Medical University,Shanghai 200003,China;Department of Surgery,Shanghai Changzheng Hospital,Second Military Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学(原第二军医大学)附属上海长征医院药材科,上海200003 [2]海军军医大学(原第二军医大学)附属上海长征医院普外一科,上海200003

出　　处：《肿瘤》2018年第11期1038-1047,共10页Tumor

摘　　要：目的:探讨癌胚抗原(carcinoembryonic antigen,CEA)、癌抗原19-9(cancer antigen19-9,CA19-9)、癌抗原125(cancerantigen125,CA125)和粪便隐血等一系列术前实验室指标联合检验对结直肠癌(colorectal cancer,CRC)的诊断价值,以及它们与炎性指标联合预测结直肠癌患者对辅助化疗的不良反应的临床价值。方法:收集上海长征医院2011年1月—2014年4月行手术治疗的859例CRC患者的回顾性临床数据,和2016年6月—2017年6月行手术治疗的251例CRC患者的前瞻性临床数据,以及TCGA数据库中617例CRC患者的临床资料。χ2检验分析影响CRC患者中CEA、CA19-9、CA125和粪便隐血假阴性率的临床病理因素,以及这些指标联合检验的诊断价值。Spearman秩相关检验分析前瞻性数据中接受术后卡培他滨方案辅助化疗的108例患者的术前肿瘤标志物、粪便隐血、炎性指标与化疗不良反应的相关性,并用受试者工作特征(receiver operating characteristic,ROC)曲线分析各项指标预测不良反应的潜在价值。结果:CEA、CA19-9和CA125用于诊断CRC的假阴性率主要受肿瘤病理分期影响(P值均<0.05),而粪便隐血用于诊断CRC的假阴性率不受病理分期影响(P> 0.05);另外,各指标单项检测用于诊断CRC的假阴性率均高于43.7%,而联合检验可降低假阴性率至18.9%(P <0.001)。术前血小板-淋巴细胞比值(platelet to lymphocyte ratio,PLR)升高可预测化疗后手足综合征,术前血小板计数减少可预测化疗后血小板缺乏,血红蛋白和白蛋白水平降低可预测贫血,粒细胞和单核细胞计数减少可预测粒细胞缺乏,而粒细胞计数减少则对预测3～4级整体骨髓抑制具有潜在作用[曲线下面积(area under curve,AUC)均> 0.6,P值均<0.05]。结论:CEA、CA19-9、CA125与粪便隐血联合检验可提高诊断CRC的敏感性,降低假阴性率。术前PLR升高具有预测手足综合征的潜在价值,而术前血细胞计数减少具有预测骨髓抑制的潜在价Objective： To evaluate the diagnostic value of a set of preoperative laboratory biomarkers including carcinoembryonic antigen （CEA）, cancer antigen 19-9 （CA19-9）, cancer antigen 125 （CA125） and fecal occult blood in colorectal cancer （CRC）, and their clinical values of combined detection with inflammatory markers in predicting adjuvant chemotherapy-related adverse effects （ACRAEs）.Methods： The clinical data from Shanghai Changzheng Hospital included 859 retrospective patients from January 2011 to April 2014 and 251 prospective patients from June 2016 to June 201 7. All patients had undergone surgical treatment. The analyzed data also included 617 patients from TCGA database. The clinicopathological factors influencing the false negative rate of diagnosis using CEA, CA19-9, CA125 and fecal occult blood in CRC patients were analyzed by Z2 test, which was also used to evaluate the diagnostic value of these markers combined detection. Spearman rank correlation test was used to evaluate the correlation of preoperative tumor markers, fecal occult blood and inflammatory markers with the adverse effects of chemotherapy in 108 patients who had received adjuvant chemotherapy with capecitabine from prospective study. The potential value of each marker to predict ACRAEs was analyzed by receiver operating characteristic （ROC） curve. Results： The false negative rates of diagnosis using CEA, CA19-9 and CA125 were mainly affected by pathological stages of CRC （all P 〈 0.05）, but the false negative rate of diagnosis using fecal occult blood were not affected （P 〉 0.05）. The false negative rate of any single marker （CEA, CA19-9, CA125, or fecal occult blood） was higher than 43.7%, while the combined detection of these markers could reduce the false negative rate to 18.9% （P 〈 0.001）. The elevated preoperative platelet to lymphocyte ratio （PLR） predicted hand foot syndrome, the reduced preoperative platelet count predicted thrombocytopenia, the reduced levels of hemoglobin and

关 键 词：结直肠肿瘤 诊断 癌胚抗原 CA19-9抗原 CA125抗原 潜血 不良反应 

分 类 号：R735.34[医药卫生—肿瘤]