Marchena J, Acosta M A, Garcia-Anguiano F, Simpson H, Cruz F
Department of Surgery, University Hospital Gran Canaria Dr. Negrin, Las Palmas, Canary Islands, Spain.
Hepatogastroenterology. 2003 Jul-Aug;50(52):1017-20.
BACKGROUND/AIMS: Preoperative carcinoembryonic antigen has been considered useful as a prognostic factor and recurrence indicator of colorectal neoplasms. However, its diagnostic ability related to some parameters such as resectability or tumor staging has been less studied. The aim of this study was to evaluate the use of this marker as a diagnostic test for these parameters of colorectal cancer.
In a sample of 283 patients operated on for colorectal carcinoma data were retrospectively recorded corresponding to preoperative carcinoembryonic antigen, type of surgery performed (curative vs. non-curative), tumor intramural spread, lymph node involvement, distant metastasis, TNM stage, tumoral differentiation, survival time and survival time free of disease. Bivariate analysis between carcinoembryonic antigen and the rest of the parameters was performed. Also, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy (efficiency) of the marker considered as a diagnostic test, were analyzed in relation to the tumoral resectability and tumoral spread.
Preoperative level of serum carcinoembryonic antigen was statistically significantly associated with type of surgery performed (p < 0.001); tumoral intramural spread (p = 0.001); lymph node involvement (p < 0.001); presence of distant metastasis (p < 0.001); TNM staging (p < 0.001); overall survival period (p < 0.001) and disease-free survival time (p = 0.04). There was no relation between carcinoembryonic antigen and the degree of tumoral differentiation. The carcinoembryonic antigen's greatest sensitivity corresponded with the prediction for the type of the surgery performed and with the existence of distant metastasis, 80% and 70.9%, respectively. The negative predictive value was also high (> 90% in both cases). When considering the intramural spread, the specificity was 82% and its positive predictive value 93.1%.
Preoperative levels of serum carcinoembryonic antigen, considered as a diagnostic test, are useful as predictors of resectability and tumor spread in colorectal carcinoma.
背景/目的：术前癌胚抗原一直被认为是结直肠肿瘤的一个有用的预后因素和复发指标。然而，其与诸如可切除性或肿瘤分期等一些参数相关的诊断能力研究较少。本研究的目的是评估该标志物作为结直肠癌这些参数的诊断试验的用途。
在283例接受结直肠癌手术的患者样本中，回顾性记录了与术前癌胚抗原、所进行的手术类型（根治性与非根治性）、肿瘤壁内扩散、淋巴结受累情况、远处转移、TNM分期、肿瘤分化程度、生存时间和无病生存时间相关的数据。对癌胚抗原与其他参数进行了双变量分析。此外，还分析了该标志物作为诊断试验时，与肿瘤可切除性和肿瘤扩散相关的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性（效率）。
术前血清癌胚抗原水平与所进行的手术类型（p < 0.001）、肿瘤壁内扩散（p = 0.001）、淋巴结受累情况（p < 0.001）、远处转移的存在（p < 0.001）、TNM分期（p < 0.001）、总生存期（p < 0.001）和无病生存时间（p = 0.04）在统计学上有显著关联。癌胚抗原与肿瘤分化程度之间无关联。癌胚抗原的最大敏感性分别对应于对所进行的手术类型和远处转移存在情况的预测，分别为80%和70.9%。阴性预测值也很高（两种情况均> 90%）。在考虑壁内扩散时，特异性为82%，阳性预测值为93.1%。
术前血清癌胚抗原水平作为一种诊断试验，可作为结直肠癌可切除性和肿瘤扩散的预测指标。
