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术后血清CEA联合CA19-9、YKL-40、CRP和IL-6预测结直肠癌复发和生存的临床价值
作者:杨昊  刘家铭  庄坤  张欣  韩坤 
单位:西安市中心医院 消化科, 陕西 西安 710003
关键词:结直肠癌 肿瘤标志物 血清炎症因子 复发 
分类号:R735.34
出版年·卷·期(页码):2022·50·第九期(1143-1150)
摘要:

目的:探讨术后血清肿瘤标志物癌胚抗原(CEA)联合糖类抗原19-9(CA19-9)、人软骨糖蛋白(YKL-40)、C反应蛋白(CRP)和白细胞介素6(IL-6)对结直肠癌(CRC)根治性切除患者复发和生存的预后价值。方法:选取2010年1月至2017年2月在我院接受根治性手术治疗的441例CRC患者作为研究对象。术后辅助化疗前采集清晨空腹静脉血,检测血清CEA、CA19-9、YKL-40、CRP、IL-6水平。随访至2021年11月或患者死亡时。采用Cox回归比例风险模型和Kaplan-Meier生存曲线分析影响术后复发和生存预后的危险因素。采用受试者工作特征(ROC)曲线分析血清学指标对于CRC的诊断和预后判断效能。结果:术后血清CEA水平预测复发的敏感度为21.3%,特异度为90.3%,阳性预测值(PPV)为80.3%。而术后血清CEA>5 μg·L-1分别联合CA19-9、YKL-40、CRP、IL-6预测患者复发风险的敏感度和PPV均升高(P<0.05)。对于血清CEA≤5 μg·L-1者,血清YKL-40>77.9 ng·ml-1的患者10年总生存期(OS)和无病生存期(DFS)均短于YKL-40≤77.9 ng·ml-1的患者(P<0.05);另外血清CRP>2.99 mg·L-1的患者10年OS短于CRP≤2.99 mg·L-1的患者(P<0.05);血清IL-6>5.4 pg·ml-1的患者10年DFS短于IL-6≤5.4 pg·ml-1的患者(P<0.05)。经Cox回归比例风险模型分析,CEA、CA19-9、YKL-40、IL-6升高是影响患者OS的独立危险因素,CEA、YKL-40、IL-6升高是影响患者DFS的独立危险因素(P<0.05)。结论:根治性切除术后血清CEA联合CA19-9、YKL-40、CRP、IL-6可作为结直肠癌复发和生存的预后指标。

Objective: To investigate the prognostic value of postoperative serum carcinoembryonic antigen(CEA) combined with carbohydrate antigen 19-9(CA19-9), human chondroglycoprotein(YKL-40), C-reactive protein(CRP) and interleukin 6(IL-6) in patients with colorectal cancer(CRC) after radical resection. Methods: A total of 441 CRC patients who received radical surgical treatment in our hospital from January 2010 to February 2017 were selected as the objects of this study. The levels of serum CEA, CA19-9, YKL-40, CRP and IL-6 were measured before adjuvant chemotherapy. The patients were followed up until November 2021 or at the time of death. Cox regression proportional risk model and Kaplan-Meier survival curve were used to analyze the risk factors for postoperative recurrence and survival. Receiver operating characteristic(ROC) curve was used to analyze the diagnostic or prognostic efficacy of serological indicators for CRC. Results: The sensitivity, pecificity and positive predictive value(PPV) of postoperative serum CEA in predicting the recurrence were 21.3%, 90.3% and 80.3% respectively. The sensitivity and PPV of postoperative serum CEA>5 μg·L-1 combined with CA19-9, YKL-40, CRP and IL-6 in predicting the recurrence were increased(P<0.05). For patients with postoperative serum CEA ≤ 5 μg·L-1, 10-year overall survival(OS) and disease-free survival(DFS) of patients with serum YKL-40>77.9 ng·ml-1 were shorter than those with serum YKL-40 ≤ 77.9 ng·ml-1(P<0.05). In addition, the 10-year OS of patients with serum CRP>2.99 mg·L-1 was shorter than that of patients with CRP ≤ 2.99 mg·L-1(P<0.05). The 10-year DFS of patients with serum IL-6>5.4 pg·ml-1 was shorter than that of patients with IL-6 ≤ 5.4 pg·ml-1(P<0.05). Cox regression proportional risk model analysis showed that the increase of CEA, CA19-9, YKL-40 and IL-6 were independent risk factors affecting OS, while the increase of CEA, YKL-40 and IL-6 were independent risk factors affecting DFS(P<0.05). Conclusion: Serum CEA combined with CA19-9, YKL-40, CRP and IL-6 after radical resection can be used as prognostic indicators for colorectal cancer recurrence and survival.

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