评估术前血清CA 242和CEA水平在结直肠癌患者分期及术后生存中的价值。

Assessment of the value of preoperative serum levels of CA 242 and CEA in the staging and postoperative survival of colorectal adenocarcinoma patients.

作者信息

Kim S B, Fernandes L C, Saad S S, Matos D

机构信息

Surgical Gastroenterology Division, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.

出版信息

Int J Biol Markers. 2003 Jul-Sep;18(3):182-7. doi: 10.1177/172460080301800305.

DOI:10.1177/172460080301800305

PMID:14535588

Abstract

INTRODUCTION

CEA is the most frequently used tumor marker in colorectal cancer. There may be an improvement in its efficacy when used in association with CA 242.

AIM

The purpose of this study was to evaluate the efficacy of preoperative serum levels of the tumor markers CA 242 and CEA in the staging and postoperative follow-up of colorectal adenocarcinoma patients.

PATIENTS AND METHODS

Of a series of 134 patients with colorectal adenocarcinomas 90 underwent radical surgery and 44 palliative surgery. The control group consisted of 22 organ donors. The cutoff serum levels utilized were 5 ng/mL for CEA and 20 U/mL for CA 242. The mortality during follow-up was recorded in order to determine the duration of survival. The data were submitted to statistical analysis using diagnostic tests, the chi-square test, survival analysis (Kaplan and Meier) and ROC curves. A significance level of p < or = 0.05 was applied.

RESULTS

The sensitivity of CEA in Dukes' stages A, B, C and D was 27.8%, 32.4%, 32.1% and 66.7%, respectively. The sensitivity of CA 242 was 11.1%, 16.2%, 30.8% and 50%. When both markers were combined, the sensitivity was 33.3%, 48.6%, 40.7% and 72.5%. In the group of patients who underwent radical surgery the mean survival was 60.47 months for those with high preoperative CEA levels, 52.22 months for those with high preoperative CA 242 levels, and 44.80 months for those with elevated levels of both markers. There was a statistically significant difference in survival between patients undergoing radical surgery with elevated CA 242 levels, especially when CEA was also elevated, and patients without elevated CA 242.

CONCLUSION

Preoperative serum levels of CA 242 showed less efficacy than CEA levels for the staging of colorectal adenocarcinoma patients. Elevated preoperative serum levels of CA 242 alone were related to poor survival, especially in association with high levels of CEA.

摘要

引言

癌胚抗原（CEA）是结直肠癌中最常用的肿瘤标志物。与CA 242联合使用时其效能可能会有所提高。

目的

本研究旨在评估术前血清肿瘤标志物CA 242和CEA水平在结直肠腺癌患者分期及术后随访中的效能。

患者与方法

在134例结直肠腺癌患者中，90例行根治性手术，44例行姑息性手术。对照组由22名器官捐献者组成。所采用的血清临界值为CEA 5 ng/mL，CA 242 20 U/mL。记录随访期间的死亡率以确定生存时间。数据采用诊断试验、卡方检验、生存分析（Kaplan和Meier法）及ROC曲线进行统计分析。应用的显著性水平为p≤0.05。

结果

CEA在Dukes分期A、B、C和D期的敏感性分别为27.8%、32.4%、32.1%和66.7%。CA 242的敏感性分别为11.1%、16.2%、30.8%和50%。当两种标志物联合使用时，敏感性分别为33.3%、48.6%、40.7%和72.5%。在接受根治性手术的患者组中，术前CEA水平高者的平均生存时间为60.47个月，术前CA 242水平高者为52.22个月，两种标志物水平均升高者为44.80个月。接受根治性手术且CA 242水平升高（尤其是CEA也升高）的患者与CA 242水平未升高的患者在生存方面存在统计学显著差异。