结直肠癌患者血液肿瘤标记物和粪便隐血结果的临床价值及相关性分析  

Clinical value and correlation analysis of blood tumor markers and fecal occult blood in patients with colorectal cancer

作　　者：徐亦君[1] 李招胜 竺明晨[2] XU Yijun;LI Zhaosheng;ZHU Mingchen(Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]南京医科大学附属南京医院·南京市第一医院,江苏南京210006 [2]江苏省肿瘤医院·江苏省肿瘤防治研究所·南京医科大学附属肿瘤医院,江苏南京210009

出　　处：《西部医学》2023年第7期987-991,共5页Medical Journal of West China

基　　金：中国博士后基金资助项目(2018M640464)。

摘　　要：目的 探讨结直肠癌(CRC)血清标志物[细胞游离DNA (cfDNA)、癌胚抗原(CEA)、碳水化合物抗原19-9 (CA19-9)]以及粪便隐血检测(FOBT)在CRC患者中的临床价值以及这些生物标记物之间的关系。方法 收集来自南京医科大学附属肿瘤医院2001年1月—2021年12月共7 537例患者的粪便和血液标志物检测结果,回顾性分析检测结果,研究标记物的诊断价值以及这些标记物与临床病理特征的关系。结果 结肠癌患者血浆cfDNA、血清CEA和CA19-9中位水平分别为17.32 ng/mL、3.59 ng/mL和15.63 U/mL。这3个标志物在直肠癌患者中的中位水平分别为15.61 ng/mL、3.15 ng/mL和12.9 U/mL。结肠癌患者血浆cfDNA和血清CEA、CA19-9水平明显高于直肠癌患者。cfDNA、FOBT、CEA和CA19-9的阳性率分别为67.90%、39.37%、48.67%、23.35%。FOBT和CEA阳性与CRC患者的性别、年龄、肿瘤部位相关。血清cfDNA和CA19-9阳性与年龄、肿瘤部位显著相关。联合检测可显著提高阳性检出率。cfDNA、FOBT、CEA和CA19-9诊断CRC的敏感性分别为56.5%、84.6%、49.9%和59.9%,特异性分别为58.6%、32.3%、84.0%和95.5%。粪便标志物FOBT与血清标志物CEA、CA19-9和cfDNA间没有显著相关性。结论 cfDNA在CRC中存在较高的阳性率,联合检测cfDNA、CEA、CA19-9及FOBT可提高结直肠癌的检出率。同时血液和粪便来源的标志物在不同临床病理资料间存在差异。Objective To investigate the clinical value of serum markers of colorectal cancer(CRC)and fecal occult blood testing(FOBT)in patients with CRC and the relationship between these biomarkers.Methods Stool and blood markers were collected from a total of 7,537 patients from Nanjing Medical University Affiliated Cancer Hospital from January 2001 to December 2021,and the diagnostic value of these markers and their relationship with clinicopathological features were retrospectively collected.Results The median levels of cfDNA,serous CEA and CA19-9 in patients with colon cancer were 17.32 ng/ml,3.59 ng/ml and 15.63 U/mL,respectively.The median levels of the three biomarkers in patients with rectal cancer were 15.61ng/ml,3.15 ng/ml and 12.9 U/ml,respectively.Plasma cfDNA,serum CEA and CA 19-9 levels in colon cancer were remarkably higher than those in rectal cancer.The positive rates of cfDNA,FOBT,CEA and CA19-9 were 67.90%,39.37%,48.67%and 23.35%respectively.The sensitivities of cfDNA,FOBT,CEA and CA19-9 were 56.5%,84.6%,49.9%and 59.9%,respectively,with specificities 58.6%,32.3%,84.0%and 95.5%,respectively.Positive FOBT and CEA significantly correlated with gender,age and tumor location of CRC patients.Likewise,positive serum cfDNA and CA19-9 were markedly correlated with age and tumor location.Joint detection of these makers could significantly improve the positive rates.Furthermore,the fecal marker FOBT was not correlated with the serum marker CEA,CA19-9and cfDNA significantly.Conclusion CfDNA has a high positive rate in colorectal cancer,and combined detection of these indicators can improve the detection rate of colorectal cancer.Moreover,our findings indicated that there were differences in the relation between these markers and CRC clinical parameters.

关 键 词：结直肠癌 粪便隐血试验 CEA CA19-9 cfDNA 

分 类 号：R735[医药卫生—肿瘤]