术前糖类抗原19-9与结直肠癌患者术后预后的关系  

Relationship between Preoperative CA19-9 Level and Postoperative Prognosis in Patients with Colorectal Cancer

作　　者：张礼 燕锦 卢进 金永东 陈萍 张轲 易波 李晓 梅开 张玉萍 Zhang Li;Yan Jin;Lu Jin;Jin Yongdong;Chen Ping;Zhang Ke;Yi Bo;Li Xiao;Mei Kai;Zhang Yuping(Department of Medical Oncology,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine^University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;Gastrointestinal Surgery Center,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学医学院肿瘤内科,成都610041 [2]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学医学院胃肠外科,成都610041

出　　处：《肿瘤预防与治疗》2021年第3期207-213,共7页Journal of Cancer Control And Treatment

摘　　要：目的:评价术前糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)水平与结直肠癌(colorectal cancer,CRC)患者术后预后的关系.方法:收集2010年~2013年在我院住院行手术治疗的419例CRC患者的临床资料.CA19-9数据不服从正态分布,故使用秩和检验分析CA19-9与CRC患者临床病理特征的关系;Kaplan-Meier法绘制CA19-9与CRC患者预后关系的生存曲线,生存曲线比较采用Log-rank检验;Cox比例风险回归模型对预后进行单因素和多因素分析.结果:术前CA19-9水平与CRC患者术后TNM分期、肿瘤最大横径、组织学类型、神经侵犯、转移情况有关(均P<0.05).术前CA19-9阳性患者较CA19-9阴性患者术后5年生存率明显下降(50.98%vs 77.14%),中位生存期明显缩短(40.36个月vs 56.59个月),两组患者的术后生存曲线的差异有统计学意义(χ2=23.501,P<0.001).将419例CRC患者按照肿瘤位置分层,术前CA19-9阳性结肠癌患者的预后也不如术前CA19-9阴性结肠癌患者,并且直肠癌患者中也有同样结果.多因素分析显示术前CA19-9水平为影响CRC患者术后预后的独立危险因素之一(P=0.033).结论:术前CA19-9水平可预测CRC患者预后,术前CA19-9呈阳性的CRC患者手术后预后更差.术前CA19-9或可识别出CRC患者中肿瘤具有高侵袭性的群体,从而有助于改善术后辅助治疗决策,提高患者预后.Objective: To evaluate the relationship between the preoperative carbohydrate antigen 19-9(CA19-9) level and postoperative prognosis in patients with colorectal cancer(CRC). Methods: Clinical data of 419 CRC patients who were hospitalized in our hospital from 2010 to 2013 were collected. Rank sum test was used to analyze the relationship between the CA19-9 level and the clinicopathological characteristics of CRC patients, as CA19-9 data were not normally distributed. Kaplan-Meier method was used to draw the survival curve indicating the relationship between the CA19-9 level and the prognosis of CRC patients. Log-rank test was used for the comparison of survival curves. The Cox proportional risk regression model was used to analyze patients’ prognosis. Results: Preoperative CA19-9 level was related to TNM stage, maximum tumor diameter, histological type, nerve invasion and metastasis(P<0.05). The 5-year survival rate of CA19-9 positive patients before operation was significantly lower than that of CA19-9 negative patients(50.98% vs 77.14%), and the median survival time of the former was significantly shorter than that of the latter(40.36 months vs 56.59 months). There was a significant difference in the postoperative survival between the two groups(χ^(2)=23.501, P<0.001). 419 CRC patients were stratified according to tumor sites. The prognosis of patients with CA19-9 positive colon cancer before operation was not as good as that of patients with CA19-9 negative colon cancer before operation, and similar result was obtained in rectal cancer patients. Multivariate analysis showed that preoperative CA19-9 level was one of the independent risk factors for postoperative prognosis of CRC patients(P=0.033). Conclusion: CA19-9 level before operation can predict the prognosis of CRC patients. The prognosis of CA19-9 positive CRC patients before operation is worse. CA19-9 may identify a highly invasive group of CRC patients before operation, and help to improve the decision-making of postoperative adjuvant treatment, so

关 键 词：糖类抗原CA19-9 结直肠癌 预后 

分 类 号：R735.35[医药卫生—肿瘤] R735.36[医药卫生—临床医学]