术前联合检测肿瘤标志物在预测食管癌预后中的意义  

The significance of preoperative combined detection of tumor markers in predicting the prognosis of esophageal cancer

作　　者：蒋之胜 胡力文[2] 丛壮壮[2] 周海 刘开超 王高明[2] 申翼[2] JIANG Zhi-sheng;HU Li-wen;CONG Zhuang-zhuang;ZHOU Hai;LIU Kai-chao;WANG Gao-ming;SHEN Yi(Graduate School,Bengbu Medical College,Bengbu 233030,Anhui,China;Department of Cardiothoracic Surgery,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]蚌埠医学院研究生院,蚌埠233030 [2]东部战区总医院(原南京军区南京总医院)心胸外科,南京210002

出　　处：《东南国防医药》2020年第5期461-467,共7页Military Medical Journal of Southeast China

基　　金：国家自然科学基金(81702444);江苏省自然科学基金(BK20160606)。

摘　　要：目的探讨术前联合检测肿瘤标志物血清水平对食管癌患者术后预后的评估意义。方法回顾性分析2014年1月至2016年12月于东部战区总医院心胸外科行食管癌根治术的276例患者临床资料并进行随访。分析术前性别、年龄、体重指数(BMI)、肿瘤标志物甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、鳞状细胞癌抗原(SCC)、Cyfra21-1血清水平及术后食管癌浸润深度、淋巴结转移、临床TNM分期、肿瘤最大直径与食管癌患者生存预后的关系;使用Kaplan-Meier法和ROC曲线分析术前联合检测肿瘤标志物对食管癌患者术后预后的评估能力。结果食管癌浸润深度、淋巴结转移、细胞分化、临床TNM分期、肿瘤最大直径与食管癌患者生存预后有关(P<0.05)。肿瘤标志物SCC、Cycra21-1血清水平均与术后临床TNM分期呈正相关关系(r=0.211,P<0.01;r=0.121,P<0.05)。SCC(P<0.001)、Cyfra21-1(P=0.001)、细胞分化(P=0.001)、TNM分期(P<0.001)是食管癌患者术后预后的独立危险因素。术前联合检测肿瘤标志物(SCC+Cyfra21-1)对食管癌患者术后预后预测的线下面积(AUC=0.707,P<0.001)优于单个指标,且略低于TNM分期(AUC=0.751,P<0.001)。结论术前联合检测肿瘤标志物(SCC+Cyfra21-1)对食管癌术后患者生存预测具有较高的敏感性,可作为食管癌预后预测的潜在标志物。Objective The significance of preoperative combined detection of serum level of tumor markers in evaluating the prognosis of patients with esophageal cancer was discussed.Methods Retrospective analysis was performed on the clinical data of 276 patients who underwent radical resection of esophageal cancer in the Department of Cardiothoracic Surgery of the General Hospital of the Eastern Theater Command from January 2014 to December 2016,and followed up.Analysis of preoperative gender,age,body mass index(BMI),the tumor markers alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9),squamous cell carcinoma antigen(SCC),Cyfra21-1 serum levels,postoperative depth of invasion,lymph node metastasis,clinical TNM stage,maximum tumor diameter and postoperative survival prognosis of esophageal cancer patients,Kaplan-Meier method and ROC curve were used to analyze the ability of preoperative combined detection of tumor markers to evaluate postoperative prognosis of patients with esophageal cancer.Results Depth of invasion,lymph node metastasis,cell differentiation,clinical TNM stage,and the maximum tumor diameter were related to the survival and prognosis of patients with esophageal cancer(P<0.05).The serum levels of preoperative tumor markers SCC and cycra21-1 were positively correlated with postoperative clinical TNM staging(r=0.211,P<0.01;r=0.121,P<0.05).SCC(P<0.001),Cyfra21-1(P=0.001),cell differentiation(P=0.001)and TNM stage(P<0.001)were independent risk factors for postoperative prognosis of esophageal cancer patients.Preoperative combined detection of tumor markers(SCC+Cyfra21-1)was better than a single indicator in predicting the prognosis of esophageal cancer patients(AUC=0.707,P<0.001),and slightly lower than TNM stage(AUC=0.751,P<0.001).Conclusion Preoperative combined detection of tumor markers(SCC+Cyfra21-1)is highly sensitive to postoperative survival prediction of patients with esophageal cancer,and can be used as a potential marker for prognosis prediction of esophageal canc

关 键 词：食管癌 肿瘤标志物 联合预测 生存预后 

分 类 号：R655.4[医药卫生—外科学]