Dorrance H R, McGregor J R, McAllister E J, O'Dwyer P J
Department of Surgery, The Western Infirmary, Glasgow, United Kingdom.
Dis Colon Rectum. 2000 Sep;43(9):1292-5; discussion 1295-6. doi: 10.1007/BF02237439.
Up to 30 percent of patients will have occult hepatic metastases at the time of curative surgery for colorectal cancer. The ability to predict this group of patients would allow better targeting of appropriate therapy. It has been shown previously that patients with overt hepatic metastases have significantly high levels of carcinoembryonic antigen in gallbladder bile compared with serum levels. The aim of this study was to assess the accuracy of bile carcinoembryonic antigen levels taken at the time of operation in predicting patients with occult hepatic metastases.
Bile and serum carcinoembryonic antigen samples were collected from 37 patients undergoing surgery for colorectal cancer, 26 of whose procedures were deemed curative and who were followed up for a median of 63.5 months.
Twelve patients were alive with no evidence of recurrent disease, and two had recurrent disease, whereas 12 died of disease. The median (interquartile range) serum carcinoembryonic antigen in the disease-free group was 2.8 (1.1-6.1) ng/ml, and in the recurrent group it was 6.35 (4.3-30) ng/ml (P = 0.006), whereas bile carcinoembryonic antigen in the disease-free group was 7 (5-39) ng/ml as compared with 31 (5-383.7) ng/ml in the recurrent group (P = 0.210). The accuracy of serum carcinoembryonic antigen in predicting occult hepatic metastases was 77 percent compared with 72 percent for bile carcinoembryonic antigen.
Intraoperative bile carcinoembryonic antigen levels are no more accurate than serum carcinoembryonic antigen levels in predicting occult hepatic metastases in patients undergoing potentially curative colorectal cancer surgery.
高达30%的患者在接受结直肠癌根治性手术时会有隐匿性肝转移。能够预测这组患者将有助于更精准地进行适当治疗。先前的研究表明，与血清水平相比，有明显肝转移的患者胆囊胆汁中的癌胚抗原水平显著升高。本研究的目的是评估手术时采集的胆汁癌胚抗原水平在预测隐匿性肝转移患者方面的准确性。
从37例行结直肠癌手术的患者中采集胆汁和血清癌胚抗原样本，其中26例手术被视为根治性手术，这些患者的中位随访时间为63.5个月。
12例患者存活且无疾病复发迹象，2例有疾病复发，12例死于疾病。无病组血清癌胚抗原的中位数（四分位间距）为2.8（1.1 - 6.1）ng/ml，复发组为6.35（4.3 - 30）ng/ml（P = 0.006），而无病组胆汁癌胚抗原为7（5 - 39）ng/ml，复发组为31（5 - 383.7）ng/ml（P = 0.210）。血清癌胚抗原预测隐匿性肝转移的准确性为77%，胆汁癌胚抗原为72%。
在预测可能接受根治性结直肠癌手术患者的隐匿性肝转移方面，术中胆汁癌胚抗原水平并不比血清癌胚抗原水平更准确。
