术前血清CYFRA 21-1水平在结直肠癌预后中的应用研究  

Application of preoperative serum CYFRA 21-1 level in the prognosis of colorectal cancer

作　　者：胡文琪 丛辉[1] 房荣华 袁文涛 冒春燕 王洁荣 王英 施秀英[1] Hu Wenqi;Cong Hui;Fang Ronghua;Yuan Wentao;Mao Chunyan;Wang Jierong;Wang Ying;Shi Xiuying(Department of Laboratory Medicine,Affiliated Hospital of Nantong University,Nantong 226001,China;Medical School,Nantong University,Nantong 226001,China;Department of Laboratory Medicine,School of Public Health,Nantong University,Nantong 226019,China)

机构地区：[1]南通大学附属医院医学检验科,南通226001 [2]南通大学医学院,南通226001 [3]南通大学公共卫生学院检验系,南通226019

出　　处：《中华预防医学杂志》2023年第10期1613-1619,共7页Chinese Journal of Preventive Medicine

基　　金：江苏省卫健委重点项目(ZD2022008);江苏省大学生创新计划重点项目(202210304050Z)。

摘　　要：探讨术前血清细胞角质蛋白19片段抗原21-1(cytokeratin 19 fragment antigen 21-1,CYFRA 21-1)对结直肠癌(colorectal cancer,CRC)手术切除患者预后的预测应用。采用回顾性研究,分析2016年1月至2018年2月在南通大学附属医院普外科接受手术治疗的CRC患者456例。收集研究对象术前CYFRA 21-1、癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)数据及病理资料,根据X-tile确定CYFRA 21-1的cut-off值,卡方检验或Fisher精确概率检验比较临床病理特征在不同CYFRA 21-1水平组的差异,单因素和多因素回归分析影响5年总生存期(overall survival,OS)、无病生存期(disease-free survival,DFS)的因素,Kaplan-Meier生存曲线分析不同水平CYFRA 21-1、CEA、CA19-9的CRC患者5年OS、DFS的差异,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析CYFRA21-1用于CRC预后的预测效能,绘制nomogram列线图预测1、3、5年生存率。结果显示血清CYFRA 21-1、CEA和CA19-9的最佳cut-off值分别为4.9 ng/ml、29.2 ng/ml和72.8 U/ml。不同性别、肿瘤大小、位置、分化程度、浸润深度、淋巴结转移和TNM分期在CYFRA 21-1高、低值两组间的差异有统计学意义,P值分别为0.018、<0.001、<0.001、<0.001、0.002、0.001、0.003。CYFRA 21-1(≥4.9 ng/ml)既是CRC患者5年OS(HR:4.008,95%CI:2.309~6.958,P<0.001)也是DFS(HR:3.75,95%CI:2.227~6.314,P<0.001)的独立危险因素。CYFRA 21-1预测5年OS和DFS的AUC分别为0.725和0.720,联合CEA、CA19-9后的AUC为0.804和0.827。根据多因素Cox回归分析结果建立OS和DFS的列线图,C指数分别是0.799和0.803。综上,术前血清CYFRA 21-1水平可能是影响结直肠癌患者预后的独立危险因素,CYFRA 21-1结合CEA、CA19-9和TNM分期等建立的预后模型,可能为预防CRC的复发和临床决策提供参考。To explore the predictive value of preoperative serum CYFRA 21-1 in colorectal cancer(CRC)resection patients.In this retrospective study,456 patients with CRC who received surgical treatment in the Department of General Surgery,Affiliated Hospital of Nantong University from January 2016 to February 2018 were analyzed.Preoperative CYFRA 21-1,CEA,CA19-9 and pathological data of the study subjects were collected.Determine the cut-off value of CYFRA 21-1 based on the X-tile.Chi-square test or Fisher exact probability test were used to compare clinicopathological features in different CYFRA 21-1 level groups.Univariate and multivariate regression analysis of factors affecting 5-year overall survival(OS)and disease-free survival(DFS).Kaplan-Meier survival curves were used to analyze 5-year differences in OS and DFS in CRC patients with different levels of CYFRA 21-1,CEA and CA19-9.Receiver operating characteristic(ROC)was adopted.ROC curves were used to analyze the prognostic efficacy of CYFRA21-1 for CRC,and nomogram maps were used to predict 1,3,and 5-year survival rates.The results showed that the optimal cut-off values of serum CYFRA 21-1,CEA and CA19-9 were 4.9 ng/ml,29.2 ng/ml and 72.8 U/ml,respectively.Different gender,tumor size,location,degree of differentiation,depth of invasion,lymph node metastasis and tumor node metastasis(TNM)classification stage were significantly different between the two groups with high and low CYFRA 21-1,the P-values were 0.018,<0.001,<0.001,<0.001,0.002,0.001,0.003,respectively.CYFRA 21-1(≥4.9 ng/ml)was an independent risk factor for 5-year OS(HR:4.008,95%CI:2.309-6.958,P<0.001)and DFS(HR:3.75,95%CI:2.227-6.314,P<0.001)in CRC patients.CYFRA 21-1 predicts a 5-year AUC of 0.725 and 0.720 for OS and DFS,respectively,and 0.804 and 0.827 for the combination of CEA and CA19-9.Based on the results of multivariate Cox regression analysis,nomogram graphs of OS and DFS were established,the C-indexes were 0.799 and 0.803,respectively.In conclusion,preoperative serum CYFRA 21-1 level may be a

关 键 词：结直肠癌 生物标志物 预后 

分 类 号：R735.3[医药卫生—肿瘤]