Levy M, Visokai V, Lipska L, Topolcan O
Thomayer Teaching Hospital, 1st Medical Faculty of Charles University Prague, Surgical Department, Prague, Czech Republic.
Neoplasma. 2008;55(2):138-42.
The precise preoperative staging of colorectal cancer is fundamental for surgical strategy, incomplete staging means incomplete treatment and poor outcome. Large-scale clinical evaluations of predictive markers are currently in progress, including determination of their ability to predict response of patients to therapy for advanced disease and for adjuvant treatment. Lack of specificity and sensitivity preclude the use of all existing serum markers for the early detection of colorectal carcinoma. The aim of the study was to investigate the clinical significance of serum tumor markers and biological activity markers -- oncofetal tumormarker CEA, mucin tumormarkers CA19-9, CA242, proliferative tumor markers Thymidine kinase, soluble cytoceratines fragments TPS, TPA, adhesive molecules ICAM - 1, VCAM -1, IGF-1, and adipocytokinins Adiponectin, Leptin in patients with colorectal cancer before primary operation. The study included 142 patients between the ages of 35 - 89 years. Operated between November 2003 to March 2006. We have confirmed that CA19-9 is besides CEA an important marker in colorectal cancer. Comparing CA19-9 and CA242 in preoperative staging, CA242 is more specific. Statistical significant difference between early and metastatic stage of colorectal cancer was not confirmed in markers: ICAM-1, VCAM, adiponectin, leptin. Statistical significant difference between early and metastatic stage of colorectal cancer was confirmed in markers: CEA, CA19-9, CA242, TPS, TPA, TK, IGF-1. None of the used markers was able to distinguish stage II and III, in other words to identify patients with infiltration of lymph nodes. This fact is very important in our aspirations to find which marker from periferal blood could help to poit out patients in risk of lymphatic infiltration and to indicate these patients for adjuvant therapy. Combination of CEA and either CA19-9 or CA242 can be recommended for preoperative investigation. CA 242 in this study seems to have slightly better results in preoperative staging.
结直肠癌精确的术前分期对于手术策略至关重要，分期不完整意味着治疗不完整且预后不佳。目前正在对预测标志物进行大规模临床评估，包括确定它们预测晚期疾病患者对治疗及辅助治疗反应的能力。缺乏特异性和敏感性使得所有现有的血清标志物都无法用于结直肠癌的早期检测。本研究的目的是调查血清肿瘤标志物和生物活性标志物——癌胚肿瘤标志物癌胚抗原（CEA）、黏蛋白肿瘤标志物糖类抗原19-9（CA19-9）、糖类抗原242（CA242）、增殖性肿瘤标志物胸苷激酶（TK）、可溶性细胞角蛋白片段组织多肽特异性抗原（TPS）、组织多肽抗原（TPA）、黏附分子细胞间黏附分子-1（ICAM - 1）、血管细胞黏附分子-1（VCAM -1）、胰岛素样生长因子-1（IGF-1）以及脂肪细胞因子脂联素（Adiponectin）、瘦素（Leptin）在结直肠癌患者初次手术前的临床意义。该研究纳入了142例年龄在35至89岁之间的患者。于2003年11月至2006年3月进行手术。我们已证实，除CEA外，CA19-9在结直肠癌中也是一个重要标志物。在术前分期中比较CA19-9和CA242，CA242更具特异性。在标志物ICAM-1、VCAM、脂联素、瘦素方面，未证实结直肠癌早期和转移期之间存在统计学显著差异。在标志物CEA、CA19-9、CA242、TPS、TPA、TK、IGF-1方面，证实结直肠癌早期和转移期之间存在统计学显著差异。所使用的标志物均无法区分II期和III期，也就是说无法识别有淋巴结浸润的患者。在我们试图找出哪种外周血标志物有助于指出有淋巴浸润风险的患者并为这些患者指明辅助治疗方向的过程中，这一事实非常重要。CEA与CA19-9或CA242联合应用可推荐用于术前检查。在本研究中，CA 242在术前分期方面似乎有稍好的结果。
